Provider Demographics
NPI:1912158577
Name:MASON, TEDMUND R (PAC)
Entity Type:Individual
Prefix:
First Name:TEDMUND
Middle Name:R
Last Name:MASON
Suffix:
Gender:M
Credentials:PAC
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Mailing Address - Street 1:8591 CROSSROAD DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-4382
Mailing Address - Country:US
Mailing Address - Phone:330-758-0577
Mailing Address - Fax:330-758-0466
Practice Address - Street 1:1499 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4008
Practice Address - Country:US
Practice Address - Phone:330-758-0577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2024-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH50.002794363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant