MEDICARE: PAUL G KASSAB 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	207R00000X	Internal Medicine Physician	221960	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0034096	OTHER		NEIGHBORHOOD HEALTH PLAN
2	2084091	OTHER		NEIGHBORHOOD HEALTH PLAN
3	1802310	OTHER	MA	HEALTHSOURCE
4	3459KA	OTHER	WA	BLUE SHIELD VM
5	AA19366	OTHER		HARVARD PILGRIM
6	J28241	OTHER		BLUE SHIELD INDEMNITY
7	J28241	OTHER		BS-BLUE CARE ELECT
8	J28241	OTHER		HMO BLUE/BLUE CHOICE
9	P00444050	OTHER	WA	RAILROAD MC # VM
10	74918	OTHER		CHILDREN'S MED. SECURITY
11	467611	OTHER		TUFTS TOTAL HEALTH PLAN
12	AA19366	OTHER		FIRST SENIORITY
13	AA19366	OTHER		HARVARD PILGRIM PPO
14	1802310	OTHER		CIGNA
15	467611	OTHER		TUFTS
16	467611	OTHER		TUFTS COMMONWEALTH PPO
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
18	467611	OTHER		TUFTS BENEFIT ADMIN.
19	AA19366	OTHER		HARVARD PILGRIM POS

General Provider Information

NPI Number	:	1740287275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL G KASSAB MD

Provider Business Mailing Address
First Line	:	1100 9TH AVE
Second Line	:	MS M4-PFS
City	:	SEATTLE
State	:	WA
Zip	:	98101-2756
Country	:	US
Telephone Number	:	206-583-6025
Fax Number	:	206-515-5886

Provider Business Practice Location Address
First Line	:	1100 9TH AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-2756
Country	:	US
Telephone Number	:	206-223-6395
Fax Number	:	206-223-6764

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	06/19/2009

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