Provider Demographics
NPI:1215030507
Name:MASK, WILLIAM KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KENNETH
Last Name:MASK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5921 BEECH BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-8115
Mailing Address - Country:US
Mailing Address - Phone:504-908-0337
Mailing Address - Fax:337-706-8930
Practice Address - Street 1:5921 BEECH BLUFF LN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-8115
Practice Address - Country:US
Practice Address - Phone:504-908-0337
Practice Address - Fax:866-722-3757
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA484512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1670189Medicaid
LA5W451Medicare PIN
LA4N501DD19Medicare PIN