Provider Demographics
NPI:1699739607
Name:MASON, REGINALD KAI (MD)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:KAI
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:PO BOX 1187
Mailing Address - Street 2:
Mailing Address - City:DUNNSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22454-1187
Mailing Address - Country:US
Mailing Address - Phone:804-445-4643
Mailing Address - Fax:
Practice Address - Street 1:2 SAINT ANTHONYS WAY STE 105
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4580
Practice Address - Country:US
Practice Address - Phone:618-465-2761
Practice Address - Fax:618-465-4750
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-03370208600000X
VA0101236379208600000X
IL036169863208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery