Provider Demographics
NPI:1982681656
Name:MASSIOS, SCOTT C (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:C
Last Name:MASSIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:530 BY PASS 123
Mailing Address - Street 2:SUITE C
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-0859
Mailing Address - Country:US
Mailing Address - Phone:864-985-1110
Mailing Address - Fax:864-985-1410
Practice Address - Street 1:530 BY PASS 123 STE C
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-0859
Practice Address - Country:US
Practice Address - Phone:864-985-1110
Practice Address - Fax:864-985-1410
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC22159207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC221593Medicaid
SC221593Medicaid
SCH25226Medicare UPIN