| Doctor Name: | DR. MARY-HELENE A MASSULLO |
| NPI Number: | 1649348343 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DO |
| License Number: | 34004036 |
| Business Practice Address: | 501 Van Buren St Suite 206 Fostoria, OH - 448301534 |
| Business Phone Number: | 4194361035 |
| Business Fax Number: | 4194360765 |
| Mailing Address: | 501 Van Buren St, Suite 206 FOSTORIA |
| State: | OH |
| Postal Code: | 448301534 |
| Phone Number: | 4194361035 |
| Fax Number: | 4194360765 |
| NPI Enumeration Date: | 12/01/2006 |
| NPI Last Update Date: | 05/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 34004036 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |