Healthcare Provider Details

I. General information

NPI: 1265932651
Provider Name (Legal Business Name): CLAIRE MASSMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 W 2ND ST
BLOOMINGTON IN
47403-2209
US

IV. Provider business mailing address

707 W 2ND ST
BLOOMINGTON IN
47403-2209
US

V. Phone/Fax

Practice location:
  • Phone: 812-334-5081
  • Fax: 812-339-8344
Mailing address:
  • Phone: 812-334-5081
  • Fax: 812-339-8344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10002440A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: