Provider Demographics
NPI:1568496420
Name:DAVID A WASSIL DO INC
Entity Type:Organization
Organization Name:DAVID A WASSIL DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:WASSIL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-637-2185
Mailing Address - Street 1:365 WINDSOR LANE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GIBSONBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43431
Mailing Address - Country:US
Mailing Address - Phone:419-637-2185
Mailing Address - Fax:419-637-2790
Practice Address - Street 1:365 WINDSOR LN
Practice Address - Street 2:SUITE 2
Practice Address - City:GIBSONBURG
Practice Address - State:OH
Practice Address - Zip Code:43431-1448
Practice Address - Country:US
Practice Address - Phone:419-637-2185
Practice Address - Fax:419-637-2790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02179OtherPARAMOUNT
OH000000173630OtherANTHEM
OH0594843Medicaid
A16190Medicare UPIN
OH0594843Medicaid
OH0897300001Medicare NSC