MEDICARE: STEVEN MASSAD 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	59849	AZ
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	59849	AZ

General Provider Information

NPI Number	:	1386095743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN MASSAD MD

Provider Business Mailing Address
First Line	:	393 LEFFERTS AVE
Second Line	:	APT 3E
City	:	BROOKLYN
State	:	NY
Zip	:	11225-4331
Country	:	US
Telephone Number	:	929-248-9028
Fax Number	:

Provider Business Practice Location Address
First Line	:	1851 MESQUITE AVE STE 202
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5681
Country	:	US
Telephone Number	:	928-854-0094
Fax Number	:	928-680-8986

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

Provider Enumeration Date	:	06/28/2016
Last Update Date	:	06/02/2020

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