Provider Demographics
NPI:1760584429
Name:MASON, DANIEL EVAN (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:EVAN
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 1:58 PINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-5425
Mailing Address - Country:US
Mailing Address - Phone:203-966-9738
Mailing Address - Fax:203-966-9738
Practice Address - Street 1:58 PINE ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5425
Practice Address - Country:US
Practice Address - Phone:203-966-9738
Practice Address - Fax:203-966-9738
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT266002084P0804X
NY1490542084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY18F251Medicare ID - Type Unspecified
NYD92996Medicare UPIN