Provider Demographics
NPI:1164403937
Name:CASSIDY, SCOTT A (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
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 1:83825 HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36251-7981
Mailing Address - Country:US
Mailing Address - Phone:256-496-2576
Mailing Address - Fax:256-354-1129
Practice Address - Street 1:83825 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:AL
Practice Address - Zip Code:36251-7981
Practice Address - Country:US
Practice Address - Phone:256-496-2576
Practice Address - Fax:256-354-1129
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036136916208600000X
AL00025351208600000X
WI62414208600000X
AL25351208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL200083846OtherTAX ID
AL310207Medicaid
AL529916800Medicaid
WI62414OtherWI STATE LIC