Healthcare Provider Details

I. General information

NPI: 1942254206
Provider Name (Legal Business Name): HENRY NORTON MASSIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2956 PIEDMONT AVE HENRY MASSIE MD
BERKELEY CA
94705-2344
US

IV. Provider business mailing address

2956 PIEDMONT AVE HENRY MASSIE MD
BERKELEY CA
94705-2344
US

V. Phone/Fax

Practice location:
  • Phone: 510-841-8107
  • Fax: 510-549-2023
Mailing address:
  • Phone: 510-841-8107
  • Fax: 510-549-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG20342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: