Provider Demographics
NPI:1053115097
Name:MASON, RANTANGIE
Entity type:Individual
Prefix:MS
First Name:RANTANGIE
Middle Name:
Last Name:MASON
Suffix:
Gender:
Credentials:
Other - Prefix:MS
Other - First Name:TANGIE
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8518 FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-4227
Mailing Address - Country:US
Mailing Address - Phone:410-245-4174
Mailing Address - Fax:
Practice Address - Street 1:8518 FOWLER AVE
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-4227
Practice Address - Country:US
Practice Address - Phone:410-245-4174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier