Basic Information
| Provider Information | |||||||||
| NPI: | 1033195698 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASSADY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | DONALD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 951603 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441930018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145464400 | ||||||||
| FaxNumber: | 6145464441 | ||||||||
| Practice Location | |||||||||
| Address1: | 6150 E BROAD ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432131574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145464345 | ||||||||
| FaxNumber: | 6145464427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2005 | ||||||||
| LastUpdateDate: | 11/08/2007 | ||||||||
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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 | 207Q00000X | 35079170 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QG0300X | 35079170 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.