Provider Demographics
NPI:1194815704
Name:MASSEY, MARGA FAITH (MD)
Entity Type:Individual
Prefix:
First Name:MARGA
Middle Name:FAITH
Last Name:MASSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 DOUGHTY ST #590
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:UT
Mailing Address - Zip Code:29401
Mailing Address - Country:US
Mailing Address - Phone:843-727-3770
Mailing Address - Fax:843-727-3774
Practice Address - Street 1:125 DOUGHTY ST STE 590
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5744
Practice Address - Country:US
Practice Address - Phone:843-727-3770
Practice Address - Fax:843-727-3774
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29224208200000X
LA201325208200000X
UT5088659-1205208200000X
MN42536208200000X
CAA72255208200000X
NC9801709208200000X
IL336-077930208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH11424Medicare UPIN