Provider Demographics
NPI:1609874403
Name:MASON, RAYMOND GREGORY (MD)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:GREGORY
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 1:3242 MCCOY RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-8904
Mailing Address - Country:US
Mailing Address - Phone:330-263-0580
Mailing Address - Fax:
Practice Address - Street 1:128 E MILLTOWN RD
Practice Address - Street 2:SUITE 205
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-6109
Practice Address - Country:US
Practice Address - Phone:330-345-2008
Practice Address - Fax:330-345-0056
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077914M207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2211645Medicaid
OHH19487Medicare UPIN
OH4026384Medicare PIN