Provider Demographics
NPI:1386635753
Name:MASSEY, LAURIE (MD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:MASSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7243
Mailing Address - Country:US
Mailing Address - Phone:508-746-5900
Mailing Address - Fax:508-747-2290
Practice Address - Street 1:148 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7243
Practice Address - Country:US
Practice Address - Phone:508-746-5900
Practice Address - Fax:508-747-2290
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222995208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
419432OtherTUFTS USFHP
MAJ28294OtherBCBS
43283986OtherUNITED
470054OtherTUFTS
7718928OtherCIGNA
MA2091470Medicaid
419432OtherTUFTS USFHP
MAA37931Medicare ID - Type Unspecified