Basic Information
Provider Information
NPI: 1548400278
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ASSAF
FirstName: WASSIM
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 415348
Address2:  
City: BOSTON
State: MA
PostalCode: 022415348
CountryCode: US
TelephoneNumber: 8002258885
FaxNumber: 5083341977
Practice Location
Address1: 48 AUBURN ST STE 1
Address2:  
City: AUBURN
State: MA
PostalCode: 015012438
CountryCode: US
TelephoneNumber: 7747727058
FaxNumber: 7747727059
Other Information
ProviderEnumerationDate: 02/20/2009
LastUpdateDate: 02/03/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/03/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X265574MAN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RS0012X265574MAY Allopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine

No ID Information.


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