Provider Demographics
NPI:1891793618
Name:MASSER, PHILIP R (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:R
Last Name:MASSER
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 1:801 PRO DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-3307
Mailing Address - Country:US
Mailing Address - Phone:419-586-3113
Mailing Address - Fax:419-586-6560
Practice Address - Street 1:801 PRO DR
Practice Address - Street 2:SUITE A
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-3307
Practice Address - Country:US
Practice Address - Phone:419-586-3113
Practice Address - Fax:419-586-6560
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049039207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0535353Medicaid
A15597Medicare UPIN
OH0535353Medicaid