Provider Demographics
NPI:1942275979
Name:CASSANEGO, ANTONIO SERGIO (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:SERGIO
Last Name:CASSANEGO
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 1:5849 OKEECHOBEE BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-4352
Mailing Address - Country:US
Mailing Address - Phone:561-683-4008
Mailing Address - Fax:561-683-0532
Practice Address - Street 1:5849 OKEECHOBEE BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4352
Practice Address - Country:US
Practice Address - Phone:561-683-4008
Practice Address - Fax:561-683-0532
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700890174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00403690OtherRAILROAD MEDICARE INDIVID
NC1126MOtherBCBS NC
NC891126MMedicaid
NC1126MOtherBCBS NC