MEDICARE: MOHAMAD MASSAN MASRI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	ME95641	FL

General Provider Information

NPI Number	:	1053361881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMAD MASSAN MASRI M.D.

Provider Business Mailing Address
First Line	:	616 E ALTAMONTE DR
Second Line	:	SUITE100
City	:	ALTAMONTE SP
State	:	FL
Zip	:	32701-4823
Country	:	US
Telephone Number	:	407-831-7755
Fax Number	:	407-831-1701

Provider Business Practice Location Address
First Line	:	616 E ALTAMONTE DR
Second Line	:	SUITE 100
City	:	ALTAMONTE SPG
State	:	FL
Zip	:	32701-4823
Country	:	US
Telephone Number	:	407-831-7755
Fax Number	:	407-831-1701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	03/07/2023

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