1134173792 NPI number — AZIZ AREF MASSAAD M.D.

Table of content: (NPI 1831695253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134173792 NPI number — AZIZ AREF MASSAAD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASSAAD
Provider First Name:
AZIZ
Provider Middle Name:
AREF
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134173792
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 317
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACHIAS
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04654-0317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-255-6831
Provider Business Mailing Address Fax Number:
207-255-6832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
229 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
MACHIAS
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04654-3606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-255-6831
Provider Business Practice Location Address Fax Number:
207-255-6832
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  014088 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208C00000X , with the licence number: 014088 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 130180099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA41896 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: P00187069 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 047954 . This is a "ANTHEM OF MAINE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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