Provider Demographics
NPI:1316549553
Name:MASON, ARCHIBALD DEQUINZEY
Entity Type:Individual
Prefix:MR
First Name:ARCHIBALD
Middle Name:DEQUINZEY
Last Name:MASON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 SHADOWROCK LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-4100
Mailing Address - Country:US
Mailing Address - Phone:202-907-7480
Mailing Address - Fax:
Practice Address - Street 1:2005 SHADOWROCK LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-4100
Practice Address - Country:US
Practice Address - Phone:202-907-7480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist