Provider Demographics
NPI:1477949865
Name:MASH, LLC
Entity Type:Organization
Organization Name:MASH, LLC
Other - Org Name:BEDSIIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORENTHIAN
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:BOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-808-1395
Mailing Address - Street 1:PO BOX 52383
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27717-2383
Mailing Address - Country:US
Mailing Address - Phone:919-808-1395
Mailing Address - Fax:919-827-4998
Practice Address - Street 1:112 S DUKE ST
Practice Address - Street 2:SUITE #1
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3172
Practice Address - Country:US
Practice Address - Phone:919-294-9410
Practice Address - Fax:919-827-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty