Provider Demographics
NPI:1699821207
Name:MASSEY, FRANK D (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:D
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 1:11951 FREEDOM DR STE 550C
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5640
Mailing Address - Country:US
Mailing Address - Phone:571-439-0068
Mailing Address - Fax:
Practice Address - Street 1:322 W NORTH RIVER DR
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3208
Practice Address - Country:US
Practice Address - Phone:509-324-6464
Practice Address - Fax:509-241-2056
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101272928207Q00000X, 2084P0800X, 2084P0800X
CO38179207Q00000X, 2084P0800X
IN01084720A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15909735Medicaid
CO15909735Medicaid
COCO307181Medicare PIN
COH40547Medicare UPIN
COCK11256Medicare PIN