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General NPI Number Information
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NPI Number | 1750787263
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Entity Type | Individual
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Provider Name | RUSTY MASON JR. CDL
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Gender | Male
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 2001 BURGESS PL
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City | FORESTVILLE
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State | MD
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Zip | 20747-1200
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Country | US
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Telephone | 202-971-6760
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 471353
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City | DISTRICT HEIGHTS
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State | MD
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Zip | 20753-1353
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Country | US
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Telephone | 202-971-6760
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 102X00000X
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Taxonomy Name | Poetry Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number | M250751019101
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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