MEDICARE: MATTHEW NEIL MASON PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	025990	NY

General Provider Information

NPI Number	:	1073011870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW NEIL MASON PA

Provider Business Mailing Address
First Line	:	601 ELMWOOD AVENUE BOX 655
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14642-8655
Country	:	US
Telephone Number	:	585-273-4398
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 JEFFERSON RD STE 100
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-3195
Country	:	US
Telephone Number	:	585-413-1800
Fax Number	:	585-413-3499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2018
Last Update Date	:	11/24/2021

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