Provider Demographics
NPI:1194791582
Name:MASSEY, ANDREW DAVID (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:DAVID
Last Name:MASSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:222 PIEDMONT AVE
Mailing Address - Street 2:STE 3100
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-4231
Mailing Address - Country:US
Mailing Address - Phone:513-475-8730
Mailing Address - Fax:513-475-8033
Practice Address - Street 1:222 PIEDMONT AVE
Practice Address - Street 2:STE 3100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-4231
Practice Address - Country:US
Practice Address - Phone:513-475-8730
Practice Address - Fax:513-475-8033
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-18143207R00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64225642Medicaid
IN201270610Medicaid
OH0685549Medicaid
OH0685549Medicaid