Basic Information
| Provider Information | |||||||||
| NPI: | 1033144241 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASSINELLI | ||||||||
| FirstName: | EZEQUIEL | ||||||||
| MiddleName: | HERNAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 PEACHTREE RD NE | ||||||||
| Address2: | SUITE 705 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043550743 | ||||||||
| FaxNumber: | 4043552136 | ||||||||
| Practice Location | |||||||||
| Address1: | 5505 PEACHTREE DUNWOODY RD NE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043550743 | ||||||||
| FaxNumber: | 4049430641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 10/22/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 059053 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0486290001 | 01 | DME | OTHER | 000000503683 | 01 | ANTHEM | OTHER | P00242139 | 01 | OH | RAILROAD MEDICARE | OTHER | 203287 | 01 | UNISON | OTHER | P00364266 | 01 | MCR RR | OTHER | 2409521 | 05 | OH | MEDICAID | 7848618 | 01 | AETNA | OTHER |