Provider Demographics
NPI:1679579338
Name:MASON, WILLIAM T (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:T
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 HOPPIN ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4141
Mailing Address - Country:US
Mailing Address - Phone:401-793-8400
Mailing Address - Fax:401-793-8402
Practice Address - Street 1:1 HOPPIN ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4141
Practice Address - Country:US
Practice Address - Phone:401-793-8400
Practice Address - Fax:401-793-8402
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD05520207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7001782Medicaid
D87545Medicare UPIN
RI7008151Medicare ID - Type Unspecified