Provider Demographics
NPI:1073555199
Name:CASSONE, GARY JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JOHN
Last Name:CASSONE
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 1:100 DUNMORE ST
Mailing Address - Street 2:
Mailing Address - City:THROOP
Mailing Address - State:PA
Mailing Address - Zip Code:18512-1442
Mailing Address - Country:US
Mailing Address - Phone:570-383-9641
Mailing Address - Fax:570-383-0833
Practice Address - Street 1:100 DUNMORE ST
Practice Address - Street 2:
Practice Address - City:THROOP
Practice Address - State:PA
Practice Address - Zip Code:18512-1442
Practice Address - Country:US
Practice Address - Phone:570-383-9641
Practice Address - Fax:570-383-0833
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019392E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB34370Medicare UPIN