Provider Demographics
NPI:1295065407
Name:M. MICHAEL MASSUMI, M.D., P.A.
Entity type:Organization
Organization Name:M. MICHAEL MASSUMI, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MASSUMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-825-5905
Mailing Address - Street 1:660 KENILWORTH DR
Mailing Address - Street 2:STE 200
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2313
Mailing Address - Country:US
Mailing Address - Phone:410-825-5905
Mailing Address - Fax:410-825-7712
Practice Address - Street 1:660 KENILWORTH DR
Practice Address - Street 2:STE 200
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2313
Practice Address - Country:US
Practice Address - Phone:410-825-5905
Practice Address - Fax:410-825-7712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0032831261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4133322OtherAETNA
MD40162901OtherCAREFIRST BLUE CROSS BLUE SHIELD
E6580000OtherCAREFIRST BLUECHOICE
025221OtherEMPLOYEE HEALTH PLANS
MD2300832OtherEVERCARE
MD2300008OtherAMERICHOICE
MD25933OtherOPTIMUM CHOICE
MD25933OtherMDIPA
MD4422MMOtherCAREFIRST BLUE CROSS BLUE SHIELD
MD091911000Medicaid
25933OtherONE NET PPO
MD03818011OtherUNITED HEALTHCARE
MD25933OtherMAMSI LIFE
426194OtherCOVENTRY
MD25933OtherMDIPA
4422MMedicare PIN