Provider Demographics
NPI:1578009346
Name:MASSARO, DEBRA JEAN (NP-C)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:JEAN
Last Name:MASSARO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:DR
Other - First Name:DEBRA
Other - Middle Name:JEAN
Other - Last Name:MASSARO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:17200 RIFFLE FORD RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2915
Mailing Address - Country:US
Mailing Address - Phone:154-044-9607
Mailing Address - Fax:
Practice Address - Street 1:13199 CENTERPOINTE WAY
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-5284
Practice Address - Country:US
Practice Address - Phone:540-449-6077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024174335Medicaid
VA0024174335Medicaid