Basic Information
| Provider Information | |||||||||
| NPI: | 1740287275 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KASSAB | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 9TH AVE | ||||||||
| Address2: | MS M4-PFS | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981012756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065836025 | ||||||||
| FaxNumber: | 2065155886 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 9TH AVE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981012756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062236395 | ||||||||
| FaxNumber: | 2062236764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2005 | ||||||||
| LastUpdateDate: | 06/19/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 221960 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0034096 | 01 | NEIGHBORHOOD HEALTH PLAN | OTHER | 2084091 | 01 | NEIGHBORHOOD HEALTH PLAN | OTHER | 1802310 | 01 | MA | HEALTHSOURCE | OTHER | 3459KA | 01 | WA | BLUE SHIELD VM | OTHER | AA19366 | 01 | HARVARD PILGRIM | OTHER | J28241 | 01 | BLUE SHIELD INDEMNITY | OTHER | J28241 | 01 | BS-BLUE CARE ELECT | OTHER | J28241 | 01 | HMO BLUE/BLUE CHOICE | OTHER | P00444050 | 01 | WA | RAILROAD MC # VM | OTHER | 74918 | 01 | CHILDREN'S MED. SECURITY | OTHER | 467611 | 01 | TUFTS TOTAL HEALTH PLAN | OTHER | AA19366 | 01 | FIRST SENIORITY | OTHER | AA19366 | 01 | HARVARD PILGRIM PPO | OTHER | 1802310 | 01 | CIGNA | OTHER | 467611 | 01 | TUFTS | OTHER | 467611 | 01 | TUFTS COMMONWEALTH PPO | OTHER | 8496986 | 05 | WA | MEDICAID | 467611 | 01 | TUFTS BENEFIT ADMIN. | OTHER | AA19366 | 01 | HARVARD PILGRIM POS | OTHER |