Provider Demographics
NPI:1508862285
Name:MASON, RICHARD J (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:510 IDLEWILD AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3883
Mailing Address - Country:US
Mailing Address - Phone:410-820-8226
Mailing Address - Fax:410-820-8405
Practice Address - Street 1:510 IDLEWILD AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3824
Practice Address - Country:US
Practice Address - Phone:410-820-8226
Practice Address - Fax:410-820-8405
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053040207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD664310800Medicaid
MDCF170011OtherCAREFIRST
MDG70253Medicare UPIN
MDCF170011OtherCAREFIRST