Provider Demographics
NPI:1740980044
Name:MICHELLE RENEE CRANIAL PROTHESIS
Entity type:Organization
Organization Name:MICHELLE RENEE CRANIAL PROTHESIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-355-6533
Mailing Address - Street 1:723 FALLSGROVE DR APT 4111
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7786
Mailing Address - Country:US
Mailing Address - Phone:240-355-6533
Mailing Address - Fax:
Practice Address - Street 1:6019 MARLBORO PIKE
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-2147
Practice Address - Country:US
Practice Address - Phone:240-355-6533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment