Provider Demographics
NPI:1063460228
Name:MASIUS, WILLIAM GLENN (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GLENN
Last Name:MASIUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601843
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9121 SAM FURR RD STE 108
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8235
Practice Address - Country:US
Practice Address - Phone:704-324-3590
Practice Address - Fax:704-324-3591
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34676207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC54571OtherBCBS
NC8954571Medicaid
SCQ34678Medicaid
NCF18581Medicare UPIN
NC2167055DMedicare PIN
010044189Medicare PIN