Healthcare Provider Details

I. General information

NPI: 1295726693
Provider Name (Legal Business Name): M SAMIR AYASSO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 CENTRE AVE SUITE 312
PITTSBURGH PA
15232-1300
US

IV. Provider business mailing address

5200 CENTRE AVE SUITE 312
PITTSBURGH PA
15232-1300
US

V. Phone/Fax

Practice location:
  • Phone: 412-321-7777
  • Fax: 412-683-8698
Mailing address:
  • Phone: 412-321-7777
  • Fax: 412-683-8698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD034257E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: