Provider Demographics
NPI:1013362359
Name:KASSAR, RAWAN F (MD)
Entity Type:Individual
Prefix:
First Name:RAWAN
Middle Name:F
Last Name:KASSAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 N MEDICAL DR STE 1100
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112-1100
Mailing Address - Country:US
Mailing Address - Phone:801-583-2787
Mailing Address - Fax:
Practice Address - Street 1:40 MEDICAL PARK STE 404
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6392
Practice Address - Country:US
Practice Address - Phone:304-243-2984
Practice Address - Fax:304-243-6306
Is Sole Proprietor?:No
Enumeration Date:2016-04-24
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV33370207RI0200X
UT12806042-1205207ZM0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical Microbiology