Basic Information
| Provider Information | |||||||||
| NPI: | 1871722132 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BARRY PAUL KASSELS M D INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 817 COFFEE RD | ||||||||
| Address2: | C3 | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953554241 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 1700 COFFEE RD | ||||||||
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| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953552803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095264500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2009 | ||||||||
| LastUpdateDate: | 07/08/2009 | ||||||||
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| AuthorizedOfficialLastName: | KASSELS | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
| AuthorizedOfficialMiddleName: | PAUL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2095299603 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | G78198 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | OOG781981 | 05 | CA | MEDICAID |