Provider Demographics
NPI:1285371955
Name:MASSE, COLBY M
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:M
Last Name:MASSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 WARNER BROOK DR APT 8201
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-4434
Mailing Address - Country:US
Mailing Address - Phone:413-663-1240
Mailing Address - Fax:
Practice Address - Street 1:300 CROSSINGS BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2878
Practice Address - Country:US
Practice Address - Phone:401-777-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant