Provider Demographics
NPI:1295821320
Name:MASSEY, DAVID B (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:MASSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-718-4820
Mailing Address - Fax:
Practice Address - Street 1:111 GATEWAY CENTER DR
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2999
Practice Address - Country:US
Practice Address - Phone:336-996-2173
Practice Address - Fax:336-996-3254
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC27487207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0103568OtherUHC OF NC
NC27614OtherMEDCOST
NC54645OtherBCBS OF NC
NC8417OtherPARTNERS MEDICARE
NC8954645Medicaid
NC8417OtherPARTNERS MEDICARE
NC8954645Medicaid
NC0103568OtherUHC OF NC
NCNC3090CMedicare PIN