Provider Demographics
NPI:1750375481
Name:MASON, SHERELL LATONYA (MD)
Entity type:Individual
Prefix:DR
First Name:SHERELL
Middle Name:LATONYA
Last Name:MASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHERELL
Other - Middle Name:LATONYA
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10 HOPKINS PLZ
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-2900
Mailing Address - Country:US
Mailing Address - Phone:301-816-7405
Mailing Address - Fax:301-388-1740
Practice Address - Street 1:10 HOPKINS PLZ
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-2900
Practice Address - Country:US
Practice Address - Phone:301-816-7405
Practice Address - Fax:301-388-1740
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDOTHOOOMedicare UPIN