Provider Demographics
NPI:1336174705
Name:MASON, KENNETH GRANT (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:GRANT
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2888
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:400 CAMPUS BLVD STE 220
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6906
Practice Address - Country:US
Practice Address - Phone:540-536-5466
Practice Address - Fax:540-536-5475
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101035681208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery