Provider Demographics
NPI:1831129147
Name:MASSELLO, THOMAS PAYNE (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:PAYNE
Last Name:MASSELLO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:111 LAKE HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-2972
Mailing Address - Country:US
Mailing Address - Phone:423-477-8258
Mailing Address - Fax:501-644-5818
Practice Address - Street 1:JAMES H. QUILLEN/VAMC
Practice Address - Street 2:CORNER OF SIDNEY AND LAMONT (JOHNSON CITY)
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684-4000
Practice Address - Country:US
Practice Address - Phone:423-979-2734
Practice Address - Fax:423-979-2696
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS08553208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery