Provider Demographics
NPI:1205141959
Name:MASON, MATILDA SYLVIA (MD)
Entity type:Individual
Prefix:DR
First Name:MATILDA
Middle Name:SYLVIA
Last Name:MASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MATILDA
Other - Middle Name:SYLVIA
Other - Last Name:ANDOH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:22 BAY VIEW TER
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-9768
Mailing Address - Country:US
Mailing Address - Phone:315-759-7119
Mailing Address - Fax:
Practice Address - Street 1:HSC T16-020
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-8478
Practice Address - Fax:631-444-7546
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09712200207R00000X
390200000X
NY268687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program