Provider Demographics
NPI:1033195698
Name:CASSADY, JAMES DONALD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DONALD
Last Name:CASSADY
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:PO BOX 951603
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0018
Mailing Address - Country:US
Mailing Address - Phone:614-546-4400
Mailing Address - Fax:614-546-4441
Practice Address - Street 1:6150 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1574
Practice Address - Country:US
Practice Address - Phone:614-546-4345
Practice Address - Fax:614-546-4427
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079170207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7342011Medicare PIN
OH4106813Medicare PIN