Provider Demographics
NPI:1689647604
Name:WASSIL, DAVID A (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:WASSIL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:365 WINDSOR LANE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GIBSONBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43431
Mailing Address - Country:US
Mailing Address - Phone:419-637-2185
Mailing Address - Fax:419-637-2790
Practice Address - Street 1:365 WINDSOR LANE
Practice Address - Street 2:SUITE 2
Practice Address - City:GIBSONBURG
Practice Address - State:OH
Practice Address - Zip Code:43431
Practice Address - Country:US
Practice Address - Phone:419-637-2185
Practice Address - Fax:419-637-2790
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000154663OtherANTHEM
OH0594843Medicaid
OH02179OtherPARAMOUNT
OH0897300001Medicare NSC
OH000000154663OtherANTHEM
A16190Medicare UPIN