MEDICARE: FADI ABBASS 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	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1205319423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FADI ABBASS MD

Provider Business Mailing Address
First Line	:	6693 N CHESTNUT ST STE 215
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-3900
Country	:	US
Telephone Number	:	330-297-9080
Fax Number	:	330-297-9077

Provider Business Practice Location Address
First Line	:	6693 N CHESTNUT ST STE 215
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-3900
Country	:	US
Telephone Number	:	330-297-9080
Fax Number	:	330-297-9077

Authorized Official
Title or Position	:	MD
Name	:	FADI ABBASS
Credential	:	MD
Telephone Number	:	330-297-9080

Provider Enumeration Date	:	09/13/2018
Last Update Date	:	09/13/2018

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