Provider Demographics
NPI:1992834345
Name:MASSING, THOMAS HARDY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:HARDY
Last Name:MASSING
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 WINDRUSH DR NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-4501
Mailing Address - Country:US
Mailing Address - Phone:815-624-0415
Mailing Address - Fax:240-218-4523
Practice Address - Street 1:700 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1830
Practice Address - Country:US
Practice Address - Phone:608-251-6100
Practice Address - Fax:608-260-2976
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2103-023363A00000X, 363AS0400X
CAPA22229363AS0400X
PAMA055679363AS0400X
COPA-3387363AS0400X
MDN008330363AS0400X
VA110001383363AS0400X
FLPA1898363AS0400X
GA002188363AS0400X
IL085-002212363AS0400X
NY16833-1363AS0400X
WI2103-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1992834345Medicaid