Provider Demographics
NPI:1427007681
Name:CASCELLA, NICOLA GERARDO (MD)
Entity Type:Individual
Prefix:
First Name:NICOLA
Middle Name:GERARDO
Last Name:CASCELLA
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 1:6501 N. CHARLES STREET
Mailing Address - Street 2:D228
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6819
Mailing Address - Country:US
Mailing Address - Phone:410-938-3000
Mailing Address - Fax:410-938-5131
Practice Address - Street 1:6501 N. CHARLES STREET
Practice Address - Street 2:D228
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6819
Practice Address - Country:US
Practice Address - Phone:410-938-3000
Practice Address - Fax:410-938-5131
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD539492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD213702000Medicaid
MD213702000Medicaid
MDH897246YMedicare ID - Type Unspecified