Provider Demographics
NPI:1376523894
Name:MASSEY, PHILIP N (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:N
Last Name:MASSEY
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 1067
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20108-1067
Mailing Address - Country:US
Mailing Address - Phone:703-361-3030
Mailing Address - Fax:703-361-2687
Practice Address - Street 1:8629 SUDLEY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4590
Practice Address - Country:US
Practice Address - Phone:703-361-3030
Practice Address - Fax:703-361-2687
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101341172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7247630Medicaid
VA7270160Medicaid
VA6688-0008OtherCAREFIRS
VA7237791Medicaid
VA7237812Medicaid
VA7237791Medicaid
VA7237821Medicare ID - Type UnspecifiedCRH
VA7247630Medicaid