Healthcare Provider Details

I. General information

NPI: 1285925644
Provider Name (Legal Business Name): AMANDA KING MASON M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA CHRISTINE KING

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FORBES STREET SUITE 200
ANNAPOLIS MD
21401
US

IV. Provider business mailing address

200 FORBES ST STE 200
ANNAPOLIS MD
21401-1599
US

V. Phone/Fax

Practice location:
  • Phone: 410-263-6363
  • Fax: 410-263-4086
Mailing address:
  • Phone: 410-263-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0078768
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: