Provider Demographics
NPI:1407894975
Name:MASSUMI, MEHRDAD MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MEHRDAD
Middle Name:MICHAEL
Last Name:MASSUMI
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 1:660 KENILWORTH DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2313
Mailing Address - Country:US
Mailing Address - Phone:410-825-5905
Mailing Address - Fax:410-825-7712
Practice Address - Street 1:660 KENILWORTH DR
Practice Address - Street 2:SUITE 200
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2313
Practice Address - Country:US
Practice Address - Phone:410-825-5905
Practice Address - Fax:410-825-7712
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD328312081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4133322OtherAETNA
MD25221OtherJOHNS HOPKINS EHP
MD25933OtherONENETPPO
MD25933OtherMDIPA
MD25933OtherOPTIMUM CHOICE
MD452330OtherAETNA HMO
MD25933OtherMAMSI LIFE & HEALTH
MD401629-01OtherCAREFIRST BCBS
DCE658OtherCAREFIRST BLUECHOICE
MD03818011OtherUNITED HEALTH CARE
MD233387OtherKAISER PERMANENTE
MD76334OtherFIRST HEALTH
MD25933OtherOPTIMUM CHOICE
4422Medicare ID - Type Unspecified