Provider Demographics
NPI:1306894688
Name:KASSISSIEH, NADIA A (MD)
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:A
Last Name:KASSISSIEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2200
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-4200
Mailing Address - Country:US
Mailing Address - Phone:603-673-9411
Mailing Address - Fax:603-673-9899
Practice Address - Street 1:2 REHABILITATION WAY
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6003
Practice Address - Country:US
Practice Address - Phone:781-935-5050
Practice Address - Fax:781-938-5639
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35225208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA134330OtherCIGNA
MA3010902Medicaid
MA80144OtherHARVARD PILGRIM
709611OtherTUFTS HEALTH PLAN
MA96983001OtherNETWORK HEALTH
MAM08621OtherBLUE CROSS BLUE SHIELD
012039OtherAETNA
709611OtherTUFTS HEALTH PLAN
MAM08621Medicare PIN