Provider Demographics
NPI:1730286568
Name:HADDAD, GHASSAN FERRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:GHASSAN
Middle Name:FERRIS
Last Name:HADDAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR - BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-232-4455
Mailing Address - Fax:440-232-3147
Practice Address - Street 1:88 CENTER RD.
Practice Address - Street 2:SUITE 130
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44146
Practice Address - Country:US
Practice Address - Phone:440-232-4455
Practice Address - Fax:440-232-3147
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079178207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000021198OtherANTHEM
0007401303OtherAETNA
OH25772OtherQUAL CHOICE
OH2268764Medicaid
0407269OtherUNITED HEALTH CARE
00000021198OtherANTHEM
0407269OtherUNITED HEALTH CARE