Provider Demographics
NPI:1598923906
Name:MASON, JONATHAN R (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:R
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 ENTERPRISE PKWY
Mailing Address - Street 2:SUITE 900
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6249
Mailing Address - Country:US
Mailing Address - Phone:757-827-2480
Mailing Address - Fax:
Practice Address - Street 1:901 ENTERPRISE PKWY
Practice Address - Street 2:SUITE 900
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6249
Practice Address - Country:US
Practice Address - Phone:757-827-2480
Practice Address - Fax:757-282-5848
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101255607207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVD636AMedicare PIN