Provider Demographics
NPI:1336123645
Name:MASON, RENEE P (DPM)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:P
Last Name:MASON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 W MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-4705
Mailing Address - Country:US
Mailing Address - Phone:276-623-0333
Mailing Address - Fax:276-623-0213
Practice Address - Street 1:1231 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-4705
Practice Address - Country:US
Practice Address - Phone:276-623-0333
Practice Address - Fax:276-623-0213
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAC10300942213ES0103X
TN486213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4350319Medicaid
VA280050OtherANTHEM
1188720001OtherADMINISTAR
VA9302107Medicaid
MAMSIOther264477
149951COtherUMWA
VA480000660Medicare PIN
VA9302107Medicaid
TN3353609Medicare PIN
VA280050OtherANTHEM