Healthcare Provider Details

I. General information

NPI: 1699972174
Provider Name (Legal Business Name): JONATHAN KEITH MASON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13821 VILLAGE MILL DR STE A
MIDLOTHIAN VA
23114-4314
US

IV. Provider business mailing address

PO BOX 549
MIDLOTHIAN VA
23113-0549
US

V. Phone/Fax

Practice location:
  • Phone: 804-794-2821
  • Fax: 804-794-4072
Mailing address:
  • Phone: 804-794-2821
  • Fax: 804-794-4072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101246747
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: