Provider Demographics
NPI:1093709289
Name:CASSIS, STEPHEN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PAUL
Last Name:CASSIS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:301 49TH ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1909
Mailing Address - Country:US
Mailing Address - Phone:304-925-3937
Mailing Address - Fax:304-925-4336
Practice Address - Street 1:301 49TH ST SE
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1909
Practice Address - Country:US
Practice Address - Phone:304-925-3937
Practice Address - Fax:304-925-4336
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2011-02-24
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Provider Licenses
StateLicense IDTaxonomies
WV12950207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0010455000Medicaid
WVA72205Medicare UPIN
WV0010455000Medicaid