Provider Demographics
NPI:1376564534
Name:LEO M CASS MDPC
Entity Type:Organization
Organization Name:LEO M CASS MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:MAXWELL
Authorized Official - Last Name:CASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-721-5025
Mailing Address - Street 1:PO BOX 2706
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01888-1306
Mailing Address - Country:US
Mailing Address - Phone:781-721-5025
Mailing Address - Fax:781-729-2297
Practice Address - Street 1:223 SWANTON ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1968
Practice Address - Country:US
Practice Address - Phone:781-721-5025
Practice Address - Fax:781-729-2297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA33744207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9719253Medicaid
MAM13230Medicare PIN