Provider Demographics
NPI:1083766190
Name:CASSIDY, DONALD (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:CASSIDY
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 1:645 N ARLINGTON AVE
Mailing Address - Street 2:SUITE 660
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4460
Mailing Address - Country:US
Mailing Address - Phone:775-770-7348
Mailing Address - Fax:
Practice Address - Street 1:645 N ARLINGTON AVE
Practice Address - Street 2:SUITE 555
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4460
Practice Address - Country:US
Practice Address - Phone:775-770-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4124207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016643Medicaid
NV002016643Medicaid