Rusty Mason Jr., CDL
Individual provider Active NPI Driver · Forestville, MD
NPI 1750787263 · NPPES record last updated Nov 10, 2014
Key facts
- NPI
- 1750787263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- M250751019101 (MD)
- Practice address
- 2001 Burgess PL
Forestville, MD 20747-1200 - Phone
- (202) 971-6760
- NPI assigned
- Nov 10, 2014
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M250751019101 | MD | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Poetry Therapist | 102X00000X | |||
| Driver | 172A00000X | M250751019101 | MD | Yes |
| Community Health Worker | 172V00000X |
Addresses
Primary practice location
2001 Burgess PL
Forestville, MD 20747-1200
Mailing address
PO Box 471353
District Heights, MD 20753-1353
Phone (202) 971-6760
Other providers in Forestville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 10, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.