Basic Information
| Provider Information | |||||||||
| NPI: | 1467651414 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABDEL MASSIH | ||||||||
| FirstName: | GEORGES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 819 WORCESTER ST 3 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011511056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135436820 | ||||||||
| FaxNumber: | 4135437962 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 S. 36TH ST. | ||||||||
| Address2: | STE. F | ||||||||
| City: | MUSKOGEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744015503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187819466 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2007 | ||||||||
| LastUpdateDate: | 11/24/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 261244 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 27748 | 01 | OK | MEDICAL LICENSE | OTHER | 200302170A | 05 | OK | MEDICAID |