Provider Demographics
NPI:1235166141
Name:MASON, CAROLINE A (MD)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:A
Last Name:MASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 CENTRE POINTE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1102
Mailing Address - Country:US
Mailing Address - Phone:651-639-9150
Mailing Address - Fax:651-639-9153
Practice Address - Street 1:1000 RADIO DR
Practice Address - Street 2:SUITE 120
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-8409
Practice Address - Country:US
Practice Address - Phone:651-735-6100
Practice Address - Fax:651-735-6106
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31720174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN324702300Medicaid
D81184Medicare UPIN