Provider Demographics
NPI:1477104073
Name:MASON, CHLOE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30485 COUNTY ROUTE 4
Mailing Address - Street 2:
Mailing Address - City:CAPE VINCENT
Mailing Address - State:NY
Mailing Address - Zip Code:13618-2176
Mailing Address - Country:US
Mailing Address - Phone:315-778-0165
Mailing Address - Fax:
Practice Address - Street 1:1575 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-9371
Practice Address - Country:US
Practice Address - Phone:315-786-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006721363A00000X
NY023949363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant