Provider Demographics
NPI:1114240249
Name:MASON, DANIELLE VICTORIA (CERTIFIED PHLEB)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:VICTORIA
Last Name:MASON
Suffix:
Gender:F
Credentials:CERTIFIED PHLEB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6479 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-3074
Mailing Address - Country:US
Mailing Address - Phone:240-579-0377
Mailing Address - Fax:
Practice Address - Street 1:2250 HICKORY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:610-834-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20-0040R07202K00000X
MD3001-0104-1155-823183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology