Provider Demographics
NPI:1639274038
Name:MASSOUH, RAFIK (MD)
Entity type:Individual
Prefix:
First Name:RAFIK
Middle Name:
Last Name:MASSOUH
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 1:8996 WEST HAMPTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133
Mailing Address - Country:US
Mailing Address - Phone:440-877-1452
Mailing Address - Fax:
Practice Address - Street 1:13207 RAVENNA ROAD
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024
Practice Address - Country:US
Practice Address - Phone:440-542-5023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024005376207R00000X, 208M00000X
TXT4973207R00000X, 208M00000X
FLME135828207R00000X, 208M00000X
NC2024-00239207R00000X, 208M00000X
OH35.072920208M00000X
OH35.072920M207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2094997Medicaid
OH0874336Medicare PIN