Provider Demographics
NPI:1578541322
Name:MASON, JOEL (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6275 E VIRGINIA BEACH BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-2851
Mailing Address - Country:US
Mailing Address - Phone:757-461-1688
Mailing Address - Fax:
Practice Address - Street 1:6275 E VIRGINIA BEACH BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2851
Practice Address - Country:US
Practice Address - Phone:757-461-1688
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA020110204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
B08015Medicare UPIN