Provider Demographics
NPI:1013982248
Name:CASSIDY, ELLEN BREEN (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:BREEN
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:300 HOSPITAL DR
Mailing Address - Street 2:STE 132
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6902
Mailing Address - Country:US
Mailing Address - Phone:410-787-4594
Mailing Address - Fax:410-787-4846
Practice Address - Street 1:8601 VETERANS HWY
Practice Address - Street 2:STE 204
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1547
Practice Address - Country:US
Practice Address - Phone:410-553-8092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2014-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD62595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H10760Medicare UPIN