Provider Demographics
NPI:1063423390
Name:MEDICAL ASSOCIATES OF MASON LLC
Entity type:Organization
Organization Name:MEDICAL ASSOCIATES OF MASON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:513-398-0015
Mailing Address - Street 1:666 READING RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1575
Mailing Address - Country:US
Mailing Address - Phone:513-398-0015
Mailing Address - Fax:315-398-0025
Practice Address - Street 1:666 READING RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1575
Practice Address - Country:US
Practice Address - Phone:513-398-0015
Practice Address - Fax:315-398-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH004427174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH272487264001OtherMEDICAL MUTUAL
OHCL5018OtherRAILROAD MEDICARE
OH2431550Medicaid
OH000000015629OtherANTHEM
OH4196743OtherAETNA
OH9315321Medicare PIN
OH000000015629OtherANTHEM