Provider Demographics
NPI:1558816926
Name:MASON, MICHAEL WAYNE (RT (R))
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:MASON
Suffix:
Gender:M
Credentials:RT (R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 LONG POINT RD
Mailing Address - Street 2:UNIT 6 BOX 31
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8286
Mailing Address - Country:US
Mailing Address - Phone:859-221-1219
Mailing Address - Fax:
Practice Address - Street 1:636 LONG POINT RD
Practice Address - Street 2:UNIT 6 BOX 31
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8286
Practice Address - Country:US
Practice Address - Phone:859-221-1219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN318226247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist