Individual
MASON DEINEMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
650 ELLIS OAK DR, CHARLESTON, SC 29425-4607
(843) 792-3451
(843) 792-3451
Mailing address
169 ASHLEY AVE RM 202, CHARLESTON, SC 29425-7994
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
87909
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/24/2022
Last updated
06/22/2023
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