Provider Demographics
NPI:1013028562
Name:MASSENGILL, ALAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D
Last Name:MASSENGILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-0308
Mailing Address - Country:US
Mailing Address - Phone:828-322-2644
Mailing Address - Fax:828-327-2235
Practice Address - Street 1:18 13TH AVE NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3748
Practice Address - Country:US
Practice Address - Phone:828-322-2644
Practice Address - Fax:828-327-2235
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97006592085B0100X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0202X, 2085R0203X, 2085R0204X, 2085R0205X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC560941927OtherUNITED HEALTHCARE
NC1039VOtherBCBS
NC891039VMedicaid
NC560941927OtherCIGNA
NC300069385OtherRAILROAD MEDICARE
NC246190OtherMAMSI
NC560941927OtherMEDCOST
NC560941927OtherUNITED HEALTHCARE
NC891039VMedicaid