Provider Demographics
NPI:1689085680
Name:MASSARY, MARY THERESA (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:THERESA
Last Name:MASSARY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 SW REGIONAL AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-4589
Mailing Address - Country:US
Mailing Address - Phone:479-464-5590
Mailing Address - Fax:479-464-5591
Practice Address - Street 1:701 SW REGIONAL AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72713-4589
Practice Address - Country:US
Practice Address - Phone:479-464-5590
Practice Address - Fax:479-464-5591
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-18636207Q00000X
NC2017-01285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine