Provider Demographics
NPI:1376650606
Name:WESTSIDE HEMATOLOGY ONCOLOGY INC
Entity Type:Organization
Organization Name:WESTSIDE HEMATOLOGY ONCOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSOUH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-808-6500
Mailing Address - Street 1:29101 HEALTH CAMPUS DR
Mailing Address - Street 2:STE 260
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5266
Mailing Address - Country:US
Mailing Address - Phone:440-808-6500
Mailing Address - Fax:440-808-8865
Practice Address - Street 1:29101 HEALTH CAMPUS DR
Practice Address - Street 2:STE 260
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5266
Practice Address - Country:US
Practice Address - Phone:440-808-6500
Practice Address - Fax:440-808-8865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056179M207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0848382Medicaid
OH000000212199OtherANTHEM
OH0848382Medicaid
D89558Medicare UPIN