# M. MICHAEL MASSUMI, M.D., P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295065407
- **Authorized official:** DR. MEHRDAD MICHAEL MASSUMI M.D. (PRESIDENT / OWNER)
- **Authorized official phone:** (410) 825-5905

## Contact information

- **Practice address:** 660 KENILWORTH DR, STE 200, TOWSON, MD 21204-2313
- **Practice address phone:** (410) 825-5905
- **Practice address fax:** (410) 825-7712
- **Mailing address:** 660 KENILWORTH DR, STE 200, TOWSON, MD 21204-2313
- **Mailing address phone:** (410) 825-5905
- **Mailing address fax:** (410) 825-7712

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | D0032831 | MD | Yes |

## Other

- **Enumeration date:** 01/11/2010
- **Last updated:** 01/11/2010

## 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 | — |