Provider Demographics
NPI:1285799148
Name:MASON, DAN E (MD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:E
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LOCKBOX #7642
Mailing Address - Street 2:PO BOX 8500
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:813-281-8115
Mailing Address - Fax:813-281-8656
Practice Address - Street 1:12502 USF PINE DRIVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9411
Practice Address - Country:US
Practice Address - Phone:813-975-7130
Practice Address - Fax:813-975-7129
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003121207X00000X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDM50640Medicaid
NY1440197Medicaid
NJ5033209Medicaid
PA1217362Medicaid
MD7725418Medicaid
VA6452159Medicaid
PA1217362Medicaid
RIDM50640Medicaid