Provider Demographics
NPI:1477054963
Name:ASSALY, AKRAM RAGHEB (PA-C)
Entity Type:Individual
Prefix:MR
First Name:AKRAM
Middle Name:RAGHEB
Last Name:ASSALY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 DORR ST # MS 840
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-4040
Mailing Address - Country:US
Mailing Address - Phone:567-420-1600
Mailing Address - Fax:467-420-1635
Practice Address - Street 1:2100 W CENTRAL AVE FL 2
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3800
Practice Address - Country:US
Practice Address - Phone:567-420-1600
Practice Address - Fax:567-420-1635
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005494RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0288053Medicaid