Provider Demographics
NPI:1740377530
Name:MASSRY, WAFIC A (MD)
Entity type:Individual
Prefix:
First Name:WAFIC
Middle Name:A
Last Name:MASSRY
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 1:1003 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4210
Mailing Address - Country:US
Mailing Address - Phone:253-403-2551
Mailing Address - Fax:
Practice Address - Street 1:1003 S 5TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-403-2551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD45016207VX0201X
TXM2316207VX0000X
IN01071285A207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01170507OtherRR MEDICARE PTAN
TX8B4477OtherBCBS OF TEXAS
IN000000776266OtherANTHEM
TX177085101Medicaid
IN201076000Medicaid
INP01170507OtherRR MEDICARE PTAN
IN000000776266OtherANTHEM
IN201076000Medicaid