Healthcare Provider Details

I. General information

NPI: 1518065580
Provider Name (Legal Business Name): LAURA S MASON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13241 RAVENNA RD STE A
CHARDON OH
44024-9012
US

IV. Provider business mailing address

24701 EUCLID AVE THIRD FLOOR BILLING SERVICES
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 440-285-9166
  • Fax: 440-285-1806
Mailing address:
  • Phone: 440-285-9166
  • Fax: 440-285-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number35-072805
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-072805
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: