Healthcare Provider Details

I. General information

NPI: 1912993882
Provider Name (Legal Business Name): JUDITH MARIE MASSET-BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 APPLE GROVE DR
BEAVERCREEK OH
45430-1466
US

IV. Provider business mailing address

3600 APPLE GROVE DR
BEAVERCREEK OH
45430-1466
US

V. Phone/Fax

Practice location:
  • Phone: 937-395-8839
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number69655
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: