Provider Demographics
NPI:1982852232
Name:M G MASSOUMI MD PA
Entity Type:Organization
Organization Name:M G MASSOUMI MD PA
Other - Org Name:PALM BEACH ORTHOPEDIC HAND CENTER, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:MASSOUMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-655-9455
Mailing Address - Street 1:1500 N DIXIE HWY
Mailing Address - Street 2:SUITE #104
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2712
Mailing Address - Country:US
Mailing Address - Phone:561-655-9455
Mailing Address - Fax:561-655-9457
Practice Address - Street 1:1500 N DIXIE HWY
Practice Address - Street 2:SUITE #104
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2712
Practice Address - Country:US
Practice Address - Phone:561-655-9455
Practice Address - Fax:561-655-9457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0021516207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55774Medicare UPIN