Provider Demographics
NPI:1669421392
Name:ASSAF, RICHARD R (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:ASSAF
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 1:2001 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:440-235-8440
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:440-235-8440
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064785207NP0225X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000141688OtherANTHEM BC/BS
OH2116230Medicaid
OH1669421392OtherANTHEM BC/BS
OH070017680OtherRAILROAD CARE
OH413025OtherWELLCARE
OHG91220Medicare UPIN
OH1669421392OtherANTHEM BC/BS
OH2116230Medicaid