Provider Demographics
NPI:1184940488
Name:MASON, JESSICA ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANNE
Last Name:MASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7185 HARBOUR TOWNE PKWY S STE 206
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3796
Mailing Address - Country:US
Mailing Address - Phone:757-484-5828
Mailing Address - Fax:757-484-4371
Practice Address - Street 1:7185 HARBOUR TOWNE PKWY S STE 206
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3796
Practice Address - Country:US
Practice Address - Phone:757-484-5828
Practice Address - Fax:757-484-4371
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256178207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1184940488Medicaid
VAVVF836BMedicare PIN