Basic Information
| Provider Information | |||||||||
| NPI: | 1104857689 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LABABIDI | ||||||||
| FirstName: | TONY | ||||||||
| MiddleName: | GHASSAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2215 E WATERLOO RD STE 313 | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443123856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302082720 | ||||||||
| FaxNumber: | 3302082721 | ||||||||
| Practice Location | |||||||||
| Address1: | 3535 S SMITH RD | ||||||||
| Address2: | STE A | ||||||||
| City: | FAIRLAWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443339270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302082720 | ||||||||
| FaxNumber: | 3302082721 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 34008085 | OH | N | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0000X | 34008085 | OH | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 11523444 | 01 | CAQH | OTHER | 2580345 | 05 | OH | MEDICAID |