Provider Demographics
NPI:1740287275
Name:KASSAB, PAUL G (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:KASSAB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:MS M4-PFS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-583-6025
Mailing Address - Fax:206-515-5886
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6395
Practice Address - Fax:206-223-6764
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA221960207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0034096OtherNEIGHBORHOOD HEALTH PLAN
2084091OtherNEIGHBORHOOD HEALTH PLAN
MA1802310OtherHEALTHSOURCE
WA3459KAOtherBLUE SHIELD VM
AA19366OtherHARVARD PILGRIM
J28241OtherBLUE SHIELD INDEMNITY
J28241OtherBS-BLUE CARE ELECT
J28241OtherHMO BLUE/BLUE CHOICE
WAP00444050OtherRAILROAD MC # VM
74918OtherCHILDREN'S MED. SECURITY
467611OtherTUFTS TOTAL HEALTH PLAN
AA19366OtherFIRST SENIORITY
AA19366OtherHARVARD PILGRIM PPO
1802310OtherCIGNA
467611OtherTUFTS
467611OtherTUFTS COMMONWEALTH PPO
WA8496986Medicaid
467611OtherTUFTS BENEFIT ADMIN.
AA19366OtherHARVARD PILGRIM POS
AA19366OtherHARVARD PILGRIM POS
AA19366OtherHARVARD PILGRIM PPO
G95582Medicare UPIN