Provider Demographics
NPI:1417916867
Name:ATASSI, MOHAMED A (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:A
Last Name:ATASSI
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 1:36100 EUCLID AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4456
Mailing Address - Country:US
Mailing Address - Phone:440-951-8360
Mailing Address - Fax:440-951-9408
Practice Address - Street 1:36100 EUCLID AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4456
Practice Address - Country:US
Practice Address - Phone:440-951-8360
Practice Address - Fax:440-951-9408
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-037183207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0259009Medicaid
OH2597481OtherUNITED HEALTHCARE
OH264168OtherFEDERAL BLACK LUNG
OH4006955OtherAETNA
OH18958OtherQUALCHOICE
OH000000130202OtherANTHEM
OH341313510AOtherSUMMACARE
OHAT0413331Medicare ID - Type Unspecified
OH341313510AOtherSUMMACARE
OH18958OtherQUALCHOICE