Provider Demographics
NPI:1588633143
Name:ASSAD, ABDOLLAH (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDOLLAH
Middle Name:
Last Name:ASSAD
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 1:628 N LAKE ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-1020
Mailing Address - Country:US
Mailing Address - Phone:775-329-1717
Mailing Address - Fax:775-329-2067
Practice Address - Street 1:628 N LAKE ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-1020
Practice Address - Country:US
Practice Address - Phone:775-329-1717
Practice Address - Fax:775-329-2067
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV108832084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVI12986Medicare UPIN
NV100586Medicare ID - Type Unspecified