Basic Information
| Provider Information | |||||||||
| NPI: | 1083807762 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASSADY | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | KAMALINI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JAMES | ||||||||
| OtherFirstName: | JESSICA | ||||||||
| OtherMiddleName: | KAMALINI | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 631395 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452631395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138622563 | ||||||||
| FaxNumber: | 5138628862 | ||||||||
| Practice Location | |||||||||
| Address1: | 375 DIXMYTH AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452202475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138622563 | ||||||||
| FaxNumber: | 5138628862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2007 | ||||||||
| LastUpdateDate: | 05/23/2012 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MT187691 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 35.098207 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.