Provider Demographics
NPI:1679722466
Name:GILL, CASSIE MARIE (CST/CFA)
Entity Type:Individual
Prefix:MS
First Name:CASSIE
Middle Name:MARIE
Last Name:GILL
Suffix:
Gender:F
Credentials:CST/CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18014 LYLES DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-9610
Mailing Address - Country:US
Mailing Address - Phone:240-409-6478
Mailing Address - Fax:
Practice Address - Street 1:18014 LYLES DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-9610
Practice Address - Country:US
Practice Address - Phone:240-409-6478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
064825246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant