Provider Demographics
NPI:1467567537
Name:MASSEY CLINIC LTD
Entity Type:Organization
Organization Name:MASSEY CLINIC LTD
Other - Org Name:MASSEY CLINIC LTD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:757-229-0919
Mailing Address - Street 1:322 MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2834
Mailing Address - Country:US
Mailing Address - Phone:757-229-0919
Mailing Address - Fax:757-229-0927
Practice Address - Street 1:322 MONTICELLO AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2834
Practice Address - Country:US
Practice Address - Phone:757-229-0919
Practice Address - Fax:757-229-0927
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MASSEY CLINIC LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-20
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA18861207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1467567537OtherGROUP NPI
VAC10955OtherGROUP PTAN
VA015815OtherANTHEM BCBS
E93741Medicare UPIN