Provider Demographics
NPI:1225283005
Name:MASON, ROYCOTT DENMORE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:ROYCOTT
Middle Name:DENMORE
Last Name:MASON
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Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:3501 SINCLAIR LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2029
Mailing Address - Country:US
Mailing Address - Phone:410-558-4888
Mailing Address - Fax:410-327-1693
Practice Address - Street 1:3120 ERDMAN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1720
Practice Address - Country:US
Practice Address - Phone:410-558-4800
Practice Address - Fax:410-675-8947
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2012-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY007517-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant