Organization Name: | MASH, LLC |
NPI Number: | 1477949865 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CORENTHIAN JEROME BOOKER (OWNER) |
Mailing Address: | 112 S Duke St Suite #1 Durham |
State: | NC US |
Postal Code: | 277013172 |
Phone Number: | 9192949410 |
Fax Number: | 9198274998 |
NPI Enumeration Date: | 04/13/2015 |
NPI Last Update Date: | 04/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |