Healthcare Provider Details

I. General information

NPI: 1609969724
Provider Name (Legal Business Name): JOHN PIERPONT MASSEY IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-2595
US

IV. Provider business mailing address

1855 SHEPHERD ST NW
WASHINGTON DC
20011-5343
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-0196
  • Fax: 301-400-0616
Mailing address:
  • Phone: 202-882-4902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD33079
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: