Healthcare Provider Details

I. General information

NPI: 1194815704
Provider Name (Legal Business Name): MARGA FAITH MASSEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DOUGHTY ST STE 590
CHARLESTON SC
29403-5744
US

IV. Provider business mailing address

125 DOUGHTY ST #590
CHARLESTON UT
29401
US

V. Phone/Fax

Practice location:
  • Phone: 843-727-3770
  • Fax: 843-727-3774
Mailing address:
  • Phone: 843-727-3770
  • Fax: 843-727-3774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number29224
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number201325
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number5088659-1205
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number42536
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA72255
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number9801709
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number336-077930
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: