Organization
PEMBROOKE SQUARE ENT ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY R MASON M.D. (OWNER)
(301) 645-4419
Entity
Organization
Contact information
Practice address
11355 PEMBROOKE SQ STE 108, WALDORF, MD 20603-4805
(301) 645-4419
(301) 645-7006
Mailing address
11355 PEMBROOKE SQ STE 108, WALDORF, MD 20603-4805
(301) 645-4419
(301) 645-7006
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
D0020369
MD
Other
Enumeration date
11/30/2007
Last updated
11/30/2007
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