Provider Demographics
NPI:1275670457
Name:MASON, MARY J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:J
Last Name:MASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 3439
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-0439
Mailing Address - Country:US
Mailing Address - Phone:843-839-4447
Mailing Address - Fax:843-399-0123
Practice Address - Street 1:3361 HWY 9 EAST
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-6041
Practice Address - Country:US
Practice Address - Phone:843-497-5929
Practice Address - Fax:843-399-0123
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC36373207Q00000X
SCTL36373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC363733Medicaid
SCSC23444560Medicare PIN
MOF49008Medicare UPIN
SCTL36373OtherSTATE LICENSE