Provider Demographics
NPI:1922012558
Name:MASON, STEPHEN B (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:B
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DUNDER RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5432
Mailing Address - Country:US
Mailing Address - Phone:802-951-9882
Mailing Address - Fax:802-524-1051
Practice Address - Street 1:24 DUNDER RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5432
Practice Address - Country:US
Practice Address - Phone:802-951-9882
Practice Address - Fax:802-524-1051
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0009249207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30205544Medicaid
VTOVN1301Medicaid
NH30205544Medicaid
VTG22865Medicare UPIN