Basic Information
| Provider Information | |||||||||
| NPI: | 1306289541 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASSA | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 633448 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452633448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134810900 | ||||||||
| FaxNumber: | 5134810904 | ||||||||
| Practice Location | |||||||||
| Address1: | 6350 GLENWAY AVE | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452116378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134810900 | ||||||||
| FaxNumber: | 5134810904 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2013 | ||||||||
| LastUpdateDate: | 06/12/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35.127099 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02041985 | 01 | OH | DOB | OTHER |