Provider Demographics
NPI:1538272182
Name:MASSEY, TODD ANDREW (DC, PA-C)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:ANDREW
Last Name:MASSEY
Suffix:
Gender:M
Credentials:DC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10502 PARK RD STE 120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8490
Mailing Address - Country:US
Mailing Address - Phone:704-272-3880
Mailing Address - Fax:
Practice Address - Street 1:10502 PARK RD STE 120
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8490
Practice Address - Country:US
Practice Address - Phone:704-272-3880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05002363A00000X
NJ25MP00307100363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-05002OtherNC MEDICAL LICENSE
NCNCL479AMedicare PIN