Provider Demographics
NPI:1437109212
Name:MASON, DEAN (CPED, BOCO,CO)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:
Last Name:MASON
Suffix:
Gender:M
Credentials:CPED, BOCO,CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W 6TH ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-1744
Mailing Address - Country:US
Mailing Address - Phone:440-244-2733
Mailing Address - Fax:440-244-2743
Practice Address - Street 1:209 W 6TH ST
Practice Address - Street 2:SUITE 12
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-1744
Practice Address - Country:US
Practice Address - Phone:440-244-2733
Practice Address - Fax:440-244-2743
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLO228 LPED 029222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHB233628OtherSUBMITTER ID
OH2068622Medicaid
OH4305690001Medicare NSC