Provider Demographics
NPI:1699763888
Name:MASON, GALE M (NP)
Entity type:Individual
Prefix:MRS
First Name:GALE
Middle Name:M
Last Name:MASON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3377 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1111
Mailing Address - Country:US
Mailing Address - Phone:413-734-5661
Mailing Address - Fax:413-734-8947
Practice Address - Street 1:3377 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1111
Practice Address - Country:US
Practice Address - Phone:413-734-5661
Practice Address - Fax:413-734-8947
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155497363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP241901OtherMEDICARE PTAN
MANP2419Medicare ID - Type Unspecified
MANP241901OtherMEDICARE PTAN