Provider Demographics
NPI:1386458099
Name:CONINE, MASON G
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:G
Last Name:CONINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 KINGS COVE CT NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-2374
Mailing Address - Country:US
Mailing Address - Phone:423-310-7706
Mailing Address - Fax:
Practice Address - Street 1:306 LIBERTY VIEW LN
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2291
Practice Address - Country:US
Practice Address - Phone:434-592-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program