Provider Demographics
NPI:1639195795
Name:MASON, ROBERT BRYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRYAN
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:PO BOX 418283
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8283
Mailing Address - Country:US
Mailing Address - Phone:703-558-1544
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007
Practice Address - Country:US
Practice Address - Phone:202-444-4972
Practice Address - Fax:202-444-7344
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD42402207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404817200Medicaid
DCP00894805OtherRAILROAD MEDICARE
VAVAA113448Medicare PIN
DC143464YT2Medicare PIN
DCP00894805OtherRAILROAD MEDICARE
H20210Medicare UPIN