Provider Demographics
NPI:1902870934
Name:MASON, JAMES S (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:S
Last Name:MASON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7785 N STATE ST STE 120
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1297
Mailing Address - Country:US
Mailing Address - Phone:315-376-4505
Mailing Address - Fax:315-376-4259
Practice Address - Street 1:7785 N STATE ST STE 120
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1297
Practice Address - Country:US
Practice Address - Phone:315-376-4505
Practice Address - Fax:313-376-4259
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027867207X00000X
NY309442207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA393116OtherBCBSGA
GAP00238249OtherRAILROAD MEDICARE
GA000790743DMedicaid
372315400OtherUNIQUE SUPPLIER IDENTIFIE
F88651Medicare UPIN
GA20NCCKQMedicare PIN