Provider Demographics
NPI:1821063678
Name:MASON, CAMILLE L (MD)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:L
Last Name:MASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 HIGHWAY 72 E
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-5254
Mailing Address - Country:US
Mailing Address - Phone:864-227-2822
Mailing Address - Fax:864-227-3410
Practice Address - Street 1:2526 HIGHWAY 72 E
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-5254
Practice Address - Country:US
Practice Address - Phone:864-227-2822
Practice Address - Fax:864-227-3410
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6749207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K0846Medicare PIN
TXH91892Medicare UPIN