Healthcare Provider Details

I. General information

NPI: 1861717100
Provider Name (Legal Business Name): MICHAEL V. MASSA, M.ED., CCC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 WALKER LN STE 411
ALEXANDRIA VA
22310-3250
US

IV. Provider business mailing address

6355 WALKER LN STE 411
ALEXANDRIA VA
22310-3250
US

V. Phone/Fax

Practice location:
  • Phone: 703-313-0373
  • Fax: 703-719-0400
Mailing address:
  • Phone: 703-922-4262
  • Fax: 703-719-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201000160
License Number StateVA

VIII. Authorized Official

Name: DR. MICHAEL V MASSA
Title or Position: PRESIDENT
Credential: AU.D.
Phone: 703-922-4262