Provider Demographics
NPI:1598040883
Name:BOND, KASSANDRA DANIELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:KASSANDRA
Middle Name:DANIELLE
Last Name:BOND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KASSANDRA
Other - Middle Name:DANIELLE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO,
Mailing Address - Street 1:825 N MAIN ST.
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066
Mailing Address - Country:US
Mailing Address - Phone:937-762-5000
Mailing Address - Fax:937-762-5099
Practice Address - Street 1:825 N MAIN ST.
Practice Address - Street 2:SUITE 140
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066
Practice Address - Country:US
Practice Address - Phone:937-762-5000
Practice Address - Fax:937-762-5099
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011129207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0102134Medicaid
OHH313251Medicare PIN
OH0102134Medicaid