Provider Demographics
NPI:1205152881
Name:MASON, BARRY MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:MICHAEL
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 1:3400 BAINBRIDGE AVE
Mailing Address - Street 2:UROLOGY DEPARTMENT
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2404
Mailing Address - Country:US
Mailing Address - Phone:718-920-7608
Mailing Address - Fax:
Practice Address - Street 1:20 GLENLAKE PKWY
Practice Address - Street 2:UROLOGY DEPARTMENT
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3473
Practice Address - Country:US
Practice Address - Phone:770-677-6075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64146208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology