MEDICARE: MICHAEL V. MASSA, M.ED., CCC INC.

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	231H00000X	Audiologist	2201000160	VA

General Provider Information

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

Provider Business Mailing Address
First Line	:	6355 WALKER LN STE 411
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-3250
Country	:	US
Telephone Number	:	703-922-4262
Fax Number	:	703-719-0400

Provider Business Practice Location Address
First Line	:	6355 WALKER LN STE 411
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-3250
Country	:	US
Telephone Number	:	703-313-0373
Fax Number	:	703-719-0400

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL V MASSA
Credential	:	AU.D.
Telephone Number	:	703-922-4262

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	10/21/2010

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