Provider Demographics
NPI:1366983835
Name:MAST, LAUREN H (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:H
Last Name:MAST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:D
Other - Last Name:HAWES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:901 ENTERPRISE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6249
Mailing Address - Country:US
Mailing Address - Phone:757-827-2480
Mailing Address - Fax:757-827-2566
Practice Address - Street 1:8525 ROLLING RD STE 300
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-3673
Practice Address - Country:US
Practice Address - Phone:703-393-1667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-005703363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical