Provider Demographics
NPI:1447557251
Name:MORRA, MASSIMO (MD, PHD, FACMG)
Entity Type:Individual
Prefix:
First Name:MASSIMO
Middle Name:
Last Name:MORRA
Suffix:
Gender:M
Credentials:MD, PHD, FACMG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 WILLOW RD STE 202
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1544
Mailing Address - Country:US
Mailing Address - Phone:650-752-1345
Mailing Address - Fax:650-752-1350
Practice Address - Street 1:1350 WILLOW RD STE 202
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-1544
Practice Address - Country:US
Practice Address - Phone:650-752-1345
Practice Address - Fax:650-752-1350
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADRN68291U00000X
FLDI43339291U00000X
NYMORRM7291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory