Provider Demographics
NPI:1114026226
Name:CARDIOLOGY ONE, INC
Entity Type:Organization
Organization Name:CARDIOLOGY ONE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:KASSIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-489-1386
Mailing Address - Street 1:4466 FULTON DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2864
Mailing Address - Country:US
Mailing Address - Phone:330-489-1386
Mailing Address - Fax:330-526-0127
Practice Address - Street 1:4466 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2864
Practice Address - Country:US
Practice Address - Phone:330-489-1386
Practice Address - Fax:330-526-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0980710207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9269611OtherOTHER MEDICARE
OH0980710Medicaid