Provider Demographics
NPI:1821075755
Name:MASIN, RICHARD R (DO)
Entity Type:Individual
Prefix:MRS
First Name:RICHARD
Middle Name:R
Last Name:MASIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 WARRENSVILLE CENTER RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5247
Mailing Address - Country:US
Mailing Address - Phone:216-367-1850
Mailing Address - Fax:216-295-0670
Practice Address - Street 1:4100 WARRENSVILLE CENTER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44122-7024
Practice Address - Country:US
Practice Address - Phone:216-367-1850
Practice Address - Fax:216-295-0670
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002641207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0516329Medicaid
OHC02499Medicare UPIN
OH0516329Medicaid
OHCF6955Medicare PIN