Provider Demographics
NPI:1952306722
Name:MASON, THOMAS P (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
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 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1314 E 7TH ST
Practice Address - Street 2:STE 206
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2533
Practice Address - Country:US
Practice Address - Phone:260-925-4939
Practice Address - Fax:260-925-4941
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045361A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200040670BMedicaid
IN192130Medicare ID - Type Unspecified
ING13069Medicare UPIN