MEDICARE: DR. MASSOUD STEPHANE MD

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	2084P0800X	Psychiatry Physician	MD61413485	WA
2	2084P0800X	Psychiatry Physician	D0052816	MD
3	2084P0800X	Psychiatry Physician	01077111A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508941204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MASSOUD STEPHANE MD

Provider Business Mailing Address
First Line	:	4030 LAKE WASHINGTON BLVD NE STE 303
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98033-7870
Country	:	US
Telephone Number	:	253-752-7320
Fax Number	:

Provider Business Practice Location Address
First Line	:	4030 LAKE WASHINGTON BLVD NE STE 303
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98033-7870
Country	:	US
Telephone Number	:	253-752-7320
Fax Number	:

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	03/13/2026

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