Provider Demographics
NPI:1093811879
Name:MASSIEN, SCOTT L (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:MASSIEN
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 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:216-285-5050
Mailing Address - Fax:216-285-4044
Practice Address - Street 1:1000 AUBURN DR # 110
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4317
Practice Address - Country:US
Practice Address - Phone:216-285-5050
Practice Address - Fax:216-285-4044
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081068207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2382112Medicaid
OH4091264Medicare PIN
OH2382112Medicaid