Matthew Bryan Mastrodomenico
THE DELTA PATHOLOGY GROUP LLC


Address: 2915 Missouri Ave, Shreveport, LA 71109-4327
Phone: 3186218820

Matthew Bryan Mastrodomenico (NPI# 1487944930, PAC ID# 1951600295) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PATHOLOGY.

Physician Overview

Nation Provider ID (NPI) 1487944930
PAC ID by PECOS 1951600295
Professional Enrollment ID I20160720002241
Full Name Matthew Bryan Mastrodomenico
Organization Legal Name THE DELTA PATHOLOGY GROUP LLC
Address 2915 Missouri Ave
Shreveport
LA 71109-4327
Phone Number 3186218820
Gender M
Medical School LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT
Graduation Year 2011
Primary Specialty PATHOLOGY
Group Practice PAC ID 4789639089
Number of Group Practice Members 51
Accepts Medicare Assignment Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
190111 WILLIS KNIGHTON MEDICAL CENTER
190041 CHRISTUS HEALTH SHREVEPORT - BOSSIER
190144 MINDEN MEDICAL CENTER
190118 DESOTO REGIONAL HEALTH SYSTEM
191312 CHRISTUS COUSHATTA HEALTH CARE CENTER

Other Locations

Address Phone Organization
2915 Missouri Ave, Shreveport, LA 71109-4327 3186218820 THE DELTA PATHOLOGY GROUP LLC

Organization Information

Organization Legal Name THE DELTA PATHOLOGY GROUP LLC
Physicians 53

Physicians with the same organization

Name Specialty Organization Address
Nancy V Smith Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Fleurette W Abreo Pathology The Delta Pathology Group LLC 1101 Medical Ctr Blvd, Marrero, LA 70072-3147
William P Long Pathology The Delta Pathology Group LLC 1101 Medical Ctr Blvd, Marrero, LA 70072-3147
Terence T Casey Pathology The Delta Pathology Group LLC 1101 Medical Ctr Blvd, Marrero, LA 70072-3147
Jill A Ferguson Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Jared D Barker Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Jonathan F Koehler Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Kirtesh H Patel Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
William A Wesche Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Stephen P Blanchard Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327

Office Location

Street Address 2915 MISSOURI AVE
City SHREVEPORT
State LA
Zip 71109-4327

Physicians in the same location

Name Specialty Organization Address
Nancy V Smith Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Jill A Ferguson Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Jared D Barker Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Jonathan F Koehler Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Kirtesh H Patel Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
William A Wesche Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Stephen P Blanchard Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Laura R Kidd Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Thomas Nicotri Jr. Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Dale J Morvant Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Find all physicians in the same address

Physicians in the same zip code

Name Specialty Organization Address
David L Jordan Optometry 2601 Jewella Ave, Shreveport, LA 71109-3205
Richard J Blanchard Jr. Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Lee R Pankey Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Vivek K Khare Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Andrew B Sholl Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Joseph S Heard Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Bruce Herrington Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Joseph C Marrazzo Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Brian L Wilkinson Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
George K Harrison Pathology The Delta Pathology Group LLC 2915 Missouri Ave, Shreveport, LA 71109-4327
Find all physicians in zip 71109

Competitor

Search similar physicians

City SHREVEPORT
Zip Code 71109
Specialty PATHOLOGY
City + Specialty SHREVEPORT + PATHOLOGY

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS)
Jurisdiction Medicare

This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.

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