Provider Demographics
NPI:1104857689
Name:LABABIDI, TONY GHASSAN (DO)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:GHASSAN
Last Name:LABABIDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 E WATERLOO RD STE 313
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-3856
Mailing Address - Country:US
Mailing Address - Phone:330-208-2720
Mailing Address - Fax:330-208-2721
Practice Address - Street 1:3535 S SMITH RD
Practice Address - Street 2:STE A
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9270
Practice Address - Country:US
Practice Address - Phone:330-208-2720
Practice Address - Fax:330-208-2721
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008085CTR207L00000X, 207LP2900X, 208VP0014X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11523444OtherCAQH
OH2580345Medicaid
11523444OtherCAQH
OHI32387Medicare UPIN