Organization
MASON PRIMARY CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANNAPURNA JASTI MAODALI MD (PRESIDENT)
(573) 339-0800
Entity
Organization
Contact information
Practice address
9311 MASON MONTGOMERY ROAD, SUITE #113, MASON, OH 45040
(513) 339-0800
(513) 339-0790
Mailing address
9311 MASON MONTGOMERY ROAD, SUITE #113, MASON, OH 45040
(513) 339-0800
(513) 339-0790
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OH35071617
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2019130
—
OH
Enumeration date
02/15/2008
Last updated
02/15/2008
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