Provider Demographics
NPI:1194732826
Name:MASSO, PETER DONALD (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:DONALD
Last Name:MASSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 CAREW STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2396
Mailing Address - Country:US
Mailing Address - Phone:413-787-2050
Mailing Address - Fax:413-787-2054
Practice Address - Street 1:516 CAREW STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2396
Practice Address - Country:US
Practice Address - Phone:413-787-2050
Practice Address - Fax:413-787-2054
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74574207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E61549Medicare UPIN