MEDICARE: BENJAMIN D MASSEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	10543	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	570989103	OTHER	SC	TAX IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1699733725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN D MASSEY M.D.

Provider Business Mailing Address
First Line	:	2750 LAUREL ST
Second Line	:	SUITE 201
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2038
Country	:	US
Telephone Number	:	803-799-2219
Fax Number	:	803-256-8539

Provider Business Practice Location Address
First Line	:	2750 LAUREL ST
Second Line	:	SUITE 201
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2038
Country	:	US
Telephone Number	:	803-256-8539
Fax Number	:	803-255-0018

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	12/10/2010

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