Provider Demographics
NPI:1801634852
Name:BASSYOUNI, OSAMA
Entity type:Individual
Prefix:
First Name:OSAMA
Middle Name:
Last Name:BASSYOUNI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-1114
Mailing Address - Country:US
Mailing Address - Phone:857-755-0126
Mailing Address - Fax:
Practice Address - Street 1:357 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-1114
Practice Address - Country:US
Practice Address - Phone:857-755-0126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4XZD28347C00000X
MASA4971606172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty
No347C00000XTransportation ServicesPrivate Vehicle