=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346393782
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARMEN BELINDA MASSEY D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1144 N ROAD ST
-----------------------------------------------------
City | ELIZABETH CITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27909-3353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-384-4449
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 151 PIER LNDG
-----------------------------------------------------
City | SOUTH MILLS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27976-9612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-771-8256
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------