Provider Demographics
NPI:1497937783
Name:GRAYBILL, CASSANDRA NOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:NOEL
Last Name:GRAYBILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8068
Practice Address - Street 1:3535 PENTAGON BLVD STE 220
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-1705
Practice Address - Country:US
Practice Address - Phone:937-429-7350
Practice Address - Fax:937-431-2623
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC129138207V00000X
WA60266839207V00000X
OH35.140441207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0415853Medicaid
OHH817380OtherMEDICARE ID