Provider Demographics
NPI:1134173792
Name:MASSAAD, AZIZ AREF (MD)
Entity type:Individual
Prefix:
First Name:AZIZ
Middle Name:AREF
Last Name:MASSAAD
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:PO BOX 317
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-0317
Mailing Address - Country:US
Mailing Address - Phone:207-255-6831
Mailing Address - Fax:207-255-6832
Practice Address - Street 1:229 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-3606
Practice Address - Country:US
Practice Address - Phone:207-255-6831
Practice Address - Fax:207-255-6832
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014088208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME130180099Medicaid
MEAA41896OtherHARVARD PILGRIM
MEP00187069OtherRAILROAD MEDICARE
ME047954OtherANTHEM OF MAINE
MEG13129Medicare UPIN
MEP00187069OtherRAILROAD MEDICARE
ME130180099Medicaid