Provider Demographics
NPI:1730159500
Name:KASSABIAN, LIBARID (MD)
Entity type:Individual
Prefix:DR
First Name:LIBARID
Middle Name:
Last Name:KASSABIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 AUDUBON AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-1001
Mailing Address - Country:US
Mailing Address - Phone:401-632-2933
Mailing Address - Fax:844-258-5605
Practice Address - Street 1:45 AUDUBON AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-1001
Practice Address - Country:US
Practice Address - Phone:401-632-2933
Practice Address - Fax:844-258-5605
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55248207Q00000X, 208D00000X
RIMD07148208D00000X, 207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI939002629Medicare PIN
D87399Medicare UPIN
RI007058379Medicare PIN