Healthcare Provider Details

I. General information

NPI: 1992732721
Provider Name (Legal Business Name): CYNTHIA R MASON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 JACKSON ST
COLUMBUS IN
47201-6264
US

IV. Provider business mailing address

806 JACKSON ST
COLUMBUS IN
47201-6264
US

V. Phone/Fax

Practice location:
  • Phone: 812-748-3412
  • Fax: 812-748-3413
Mailing address:
  • Phone: 812-748-3412
  • Fax: 812-748-3413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number01038639
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: