Provider Demographics
NPI:1700831914
Name:MASSEY, CLINTON EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:EDWARD
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:PO BOX 751069
Mailing Address - Street 2:GOLDSBORO NEUROLOGICAL SURGERY
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 COUNTRY DAY RD
Practice Address - Street 2:GOLDSBORO NEUROLOGICAL SURGERY
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-8888
Practice Address - Country:US
Practice Address - Phone:919-731-4048
Practice Address - Fax:919-731-2402
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201492207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89133T8Medicaid
NC133T8OtherBLUE CROSS BLUE SHIELD
NCP00444727OtherMEDICARE RR
NCNC1892AMedicare PIN
NC133T8OtherBLUE CROSS BLUE SHIELD
NC89133T8Medicaid
NC1079140001Medicare NSC