Provider Demographics
NPI:1962636639
Name:LANCE S CASSELL MD PA
Entity Type:Organization
Organization Name:LANCE S CASSELL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-961-4967
Mailing Address - Street 1:5687 EASTWIND DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5075
Mailing Address - Country:US
Mailing Address - Phone:941-961-4967
Mailing Address - Fax:
Practice Address - Street 1:6400 EDGELAKE DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-8813
Practice Address - Country:US
Practice Address - Phone:941-961-4967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86655225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME86655OtherMEDICAL LICENSE