Provider Demographics
NPI:1164459715
Name:WILLIAMS, MASON MILLER (MD)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:MILLER
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5899 BREMO RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1935
Mailing Address - Country:US
Mailing Address - Phone:804-285-4115
Mailing Address - Fax:804-673-6714
Practice Address - Street 1:5899 BREMO RD
Practice Address - Street 2:SUITE 205
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1935
Practice Address - Country:US
Practice Address - Phone:804-285-4115
Practice Address - Fax:804-673-6714
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010260652086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6961231Medicaid
VAB07116Medicare UPIN
VA240000067Medicare ID - Type Unspecified