Provider Demographics
NPI:1225615933
Name:MASCIOLI, MATTHEW C (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:MASCIOLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26194
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2012
Mailing Address - Country:US
Mailing Address - Phone:865-909-0744
Mailing Address - Fax:833-908-2120
Practice Address - Street 1:1267 DICK LONAS RD STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1326
Practice Address - Country:US
Practice Address - Phone:865-909-0744
Practice Address - Fax:833-908-2120
Is Sole Proprietor?:No
Enumeration Date:2021-03-27
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02007815A207R00000X
TN6295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine