Healthcare Provider Details

I. General information

NPI: 1669421392
Provider Name (Legal Business Name): RICHARD R ASSAF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 CROCKER RD SUITE 150
WESTLAKE OH
44145-6966
US

IV. Provider business mailing address

2001 CROCKER RD SUITE 150
WESTLAKE OH
44145-6966
US

V. Phone/Fax

Practice location:
  • Phone: 440-871-0410
  • Fax: 440-235-8440
Mailing address:
  • Phone: 440-871-0410
  • Fax: 440-235-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35064785
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number35064785
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number35064785
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: