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General NPI Number Information
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NPI Number | 1861717100
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Entity Type | Organization
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Legal Business Name | MICHAEL V. MASSA, M.ED., CCC INC.
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Dates
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Enumeration Date | 03/30/2010
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 6355 WALKER LN STE 411
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City | ALEXANDRIA
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State | VA
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Zip | 22310-3250
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Country | US
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Telephone | 703-313-0373
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Fax | 703-719-0400
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Provider Business Mailing Address
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Address Line | 6355 WALKER LN STE 411
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City | ALEXANDRIA
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State | VA
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Zip | 22310-3250
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Country | US
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Telephone | 703-922-4262
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Fax | 703-719-0400
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL V MASSA
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Credential | AU.D.
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Telephone | 703-922-4262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 2201000160
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License Number State | VA
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