Provider Demographics
NPI:1326080466
Name:MASON, JOSEPH T (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:T
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5372 FALLOWATER LN
Mailing Address - Street 2:STE. C
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0907
Mailing Address - Country:US
Mailing Address - Phone:540-772-1974
Mailing Address - Fax:540-283-0032
Practice Address - Street 1:5372 FALLOWATER LN
Practice Address - Street 2:STE. C
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0907
Practice Address - Country:US
Practice Address - Phone:540-772-1974
Practice Address - Fax:540-283-0032
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA010144833732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007107901Medicaid
VAF30021Medicare UPIN
VA007107901Medicaid