Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 55248 | MA |
Y | 207Q00000X | Family Doctor | MD07148 | RI |
N | 207QA0401X | Family Doctor - Addiction Medicine | MD07148 | RI |
NPI | 1730159500 |
---|---|
Provider Name | Dr. Libarid Kassabian |
First Address | Providence, RI 02908-1001 |
Second Address | Barrington, RI 02806-3430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 22/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D87399 | (02) |