Basic Information
| Provider Information | |||||||||
| NPI: | 1144226671 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASSOUD | ||||||||
| FirstName: | SAMUEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 TECH PARK DR | ||||||||
| Address2: | SUITE 1150 | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159012515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144758100 | ||||||||
| FaxNumber: | 8144758797 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 TECH PARK DR | ||||||||
| Address2: | SUITE 1150 | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159012515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144758700 | ||||||||
| FaxNumber: | 8144758752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 02/25/2019 | ||||||||
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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 | 207R00000X | MD059293L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.