Provider Demographics
NPI:1992030704
Name:RICHARD ASSAF DERMATOLOGY, INC.
Entity Type:Organization
Organization Name:RICHARD ASSAF DERMATOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:ASSAF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-871-0410
Mailing Address - Street 1:2001 CROCKER RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-6966
Mailing Address - Country:US
Mailing Address - Phone:440-871-0410
Mailing Address - Fax:888-421-2247
Practice Address - Street 1:2001 CROCKER RD
Practice Address - Street 2:SUITE 150
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-6966
Practice Address - Country:US
Practice Address - Phone:440-871-0410
Practice Address - Fax:888-421-2247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064785207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty