Provider Demographics
NPI:1619947918
Name:MASON, R WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:R WILLIAM
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 1:40 WOODS END RD
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-5823
Mailing Address - Country:US
Mailing Address - Phone:781-444-4722
Mailing Address - Fax:781-444-4721
Practice Address - Street 1:15 OAK ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2401
Practice Address - Country:US
Practice Address - Phone:781-444-4722
Practice Address - Fax:781-444-4721
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37217207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6176283Medicaid
MAC16117Medicare PIN
MA6176283Medicaid