Healthcare Provider Details

I. General information

NPI: 1477581437
Provider Name (Legal Business Name): MICHAEL DOYLE MASON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 GUEST ST SUITE 225
BRIGHTON MA
02135-2040
US

IV. Provider business mailing address

20 GUEST ST SUITE 225
BRIGHTON MA
02135-2040
US

V. Phone/Fax

Practice location:
  • Phone: 617-738-8642
  • Fax: 617-491-2552
Mailing address:
  • Phone: 617-738-8642
  • Fax: 617-491-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number80434
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number80434
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: