Provider Demographics
NPI:1760481428
Name:MASSI, JAMES L (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:MASSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:100 GRAND ST
Mailing Address - Street 2:DEPARTMENT OF SURGERY
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-2016
Mailing Address - Country:US
Mailing Address - Phone:860-224-5513
Mailing Address - Fax:860-224-5713
Practice Address - Street 1:100 GRAND ST
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-2016
Practice Address - Country:US
Practice Address - Phone:860-224-5513
Practice Address - Fax:860-224-5713
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT018040208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001180405Medicaid
CT020000420Medicare ID - Type Unspecified
CT001180405Medicaid