Provider Demographics
NPI:1013954387
Name:NEUROSURGICAL ASSOCIATES CASSIDY & GUERIN, MD, PA
Entity type:Organization
Organization Name:NEUROSURGICAL ASSOCIATES CASSIDY & GUERIN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-484-3404
Mailing Address - Street 1:842 SUNSET LAKE BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-7552
Mailing Address - Country:US
Mailing Address - Phone:941-484-3404
Mailing Address - Fax:941-496-7895
Practice Address - Street 1:842 SUNSET LAKE BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-7552
Practice Address - Country:US
Practice Address - Phone:941-484-3404
Practice Address - Fax:941-496-7895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDME78002207T00000X
VAME0057567207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL952967OtherAETNA DR CASSIDY
FL46419OtherBC/BS
FL10392OtherBC/BS
FL219802OtherAMERIGROUP
FL2175307OtherAETNA DR GUERIN
FL219802OtherAMERIGROUP
FL952967OtherAETNA DR CASSIDY
FL10392Medicare ID - Type UnspecifiedCASSIDY INDIVIDUAL NUMBER
FL46419Medicare ID - Type UnspecifiedGUERIN INDIVIDUAL NUMBER
FLK1140AMedicare ID - Type UnspecifiedGROUP NUMBER
FL1024450001Medicare NSC