Provider Demographics
NPI:1053361881
Name:MASRI, MOHAMAD MASSAN (MD)
Entity type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:MASSAN
Last Name:MASRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 E ALTAMONTE DR
Mailing Address - Street 2:SUITE100
Mailing Address - City:ALTAMONTE SP
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4823
Mailing Address - Country:US
Mailing Address - Phone:407-831-7755
Mailing Address - Fax:407-831-1701
Practice Address - Street 1:616 E ALTAMONTE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ALTAMONTE SPG
Practice Address - State:FL
Practice Address - Zip Code:32701-4823
Practice Address - Country:US
Practice Address - Phone:407-831-7755
Practice Address - Fax:407-831-1701
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95641207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBM5839557OtherDEA