MEDICARE: LAURIE GREER MASSA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NS0135X	Procedural Dermatology Physician	34944	KY
2	207N00000X	Dermatology Physician	34944	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0300105	OTHER	UNITED HEALTHCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000044790	OTHER	ANTHEM
4	C03026	OTHER	CUMBERLAND HEALTHCARE

General Provider Information

NPI Number	:	1427051721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE GREER MASSA M.D.

Provider Business Mailing Address
First Line	:	1221 S BROADWAY
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-2701
Country	:	US
Telephone Number	:	859-258-6200
Fax Number	:	859-258-6203

Provider Business Practice Location Address
First Line	:	250 FOUNTAIN CT
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1888
Country	:	US
Telephone Number	:	859-263-4444
Fax Number	:	859-254-1814

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	10/05/2023

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