Provider Demographics
NPI:1689029084
Name:MASSIE, AIDA CHRISTINA
Entity Type:Individual
Prefix:MRS
First Name:AIDA
Middle Name:CHRISTINA
Last Name:MASSIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7217 STARBOARD DR
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1785
Mailing Address - Country:US
Mailing Address - Phone:202-798-2502
Mailing Address - Fax:
Practice Address - Street 1:124 RITTENHOUSE ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1516
Practice Address - Country:US
Practice Address - Phone:202-798-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
MD213709171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No174400000XOther Service ProvidersSpecialist