Provider Demographics
NPI:1295775716
Name:KASSIR, MOHAMAD S (MD)
Entity type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:S
Last Name:KASSIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4455 DRESSLER NWRD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2785
Mailing Address - Country:US
Mailing Address - Phone:330-837-6841
Mailing Address - Fax:330-830-4456
Practice Address - Street 1:4466 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2864
Practice Address - Country:US
Practice Address - Phone:330-489-1386
Practice Address - Fax:330-489-1258
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-2681-K207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
110085843OtherMEDICARE RAILROAD
OH0866479Medicaid
OH0866479Medicaid
OHKA0710472Medicare ID - Type Unspecified