Provider Demographics
NPI:1386749307
Name:CHARLES W. MASON, D.O., GERIATRIC MEDICINE
Entity type:Organization
Organization Name:CHARLES W. MASON, D.O., GERIATRIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-881-9190
Mailing Address - Street 1:8530 NORTHBLUFF LN
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8084
Mailing Address - Country:US
Mailing Address - Phone:740-881-9190
Mailing Address - Fax:
Practice Address - Street 1:8530 NORTHBLUFF LN
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8084
Practice Address - Country:US
Practice Address - Phone:740-881-9190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0198610Medicaid
F06589Medicare UPIN
OH9327301Medicare PIN