Provider Demographics
NPI:1689835944
Name:ABAZID, BASSEM A (MD)
Entity Type:Individual
Prefix:
First Name:BASSEM
Middle Name:A
Last Name:ABAZID
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 1:576 LOUDOUN MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772
Mailing Address - Country:US
Mailing Address - Phone:865-988-9970
Mailing Address - Fax:865-271-6621
Practice Address - Street 1:576 LOUDOUN MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772
Practice Address - Country:US
Practice Address - Phone:865-988-9970
Practice Address - Fax:865-271-6621
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD53164207RC0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ019208Medicaid
TNQ019208Medicaid
AL051119345OtherBCBS
AL132001Medicaid
AL051119344OtherBCBS
AL051119343OtherBCBS
AL132009Medicaid
AL102I119000Medicare PIN