Provider Demographics
NPI:1083810501
Name:ROBERT E CASSIDY MD PC
Entity Type:Organization
Organization Name:ROBERT E CASSIDY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-623-4545
Mailing Address - Street 1:332 JEFFERSON DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-0379
Mailing Address - Country:US
Mailing Address - Phone:336-623-4545
Mailing Address - Fax:206-333-1892
Practice Address - Street 1:332 JEFFERSON DAVIS DR
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-0379
Practice Address - Country:US
Practice Address - Phone:336-623-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053359261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00W469R01Medicare PIN
VAA40146Medicare UPIN