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Organization
M. MICHAEL MASSUMI, M.D., P.A.
Active
Organization
M. MICHAEL MASSUMI, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MEHRDAD MICHAEL MASSUMI M.D. (PRESIDENT / OWNER)
(410) 825-5905
Entity
Organization
Contact information
Practice address
660 KENILWORTH DR, STE 200, TOWSON, MD 21204-2313
(410) 825-5905
(410) 825-7712
Mailing address
660 KENILWORTH DR, STE 200, TOWSON, MD 21204-2313
(410) 825-5905
(410) 825-7712
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
D0032831
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025221
EMPLOYEE HEALTH PLANS
—
01
—
03818011
UNITED HEALTHCARE
MD
05
—
091911000
—
MD
01
—
2300008
AMERICHOICE
MD
01
—
2300832
EVERCARE
MD
01
—
25933
MAMSI LIFE
MD
01
—
25933
ONE NET PPO
—
01
—
40162901
CAREFIRST BLUE CROSS BLUE SHIELD
MD
01
—
4133322
AETNA
—
01
—
426194
COVENTRY
—
01
—
4422MM
CAREFIRST BLUE CROSS BLUE SHIELD
MD
01
—
E6580000
CAREFIRST BLUECHOICE
—
Enumeration date
01/11/2010
Last updated
01/11/2010
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