Provider Demographics
NPI:1003813205
Name:SAFADI, GHASSAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:GHASSAN
Middle Name:S
Last Name:SAFADI
Suffix:
Gender:M
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:PO BOX 352108
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43635-2108
Mailing Address - Country:US
Mailing Address - Phone:419-843-7780
Mailing Address - Fax:419-517-0216
Practice Address - Street 1:7640 SYLVANIA AVE
Practice Address - Street 2:J
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9729
Practice Address - Country:US
Practice Address - Phone:419-843-7780
Practice Address - Fax:419-517-0216
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2011-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062753207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00274723OtherRAILROAD MEDICARE ID
OH0880953Medicaid
OH03576OtherPARAMOUNT HEALTH CARE
OH0880953Medicaid
OH4133133Medicare ID - Type UnspecifiedMEDIARE NUMBER