Healthcare Provider Details

I. General information

NPI: 1437787801
Provider Name (Legal Business Name): KATHERINE ANN MASS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 9TH ST N
VIRGINIA MN
55792-2329
US

IV. Provider business mailing address

1906 BELLEVIEW AVE SE DEPT OF
ROANOKE VA
24014-1838
US

V. Phone/Fax

Practice location:
  • Phone: 218-305-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number82368
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: