Provider Demographics
NPI:1205916632
Name:CASS, DARRELL L (MD)
Entity type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:L
Last Name:CASS
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 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-445-5760
Mailing Address - Fax:216-445-1035
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-445-5760
Practice Address - Fax:216-445-1035
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK305572086S0120X
IN01079052A2086S0120X
TXL21752086S0120X
OH35.1319982086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144498601Medicaid
TX144498602Medicaid
TX144498604Medicaid
TX144498605OtherCSHCN
TX144498604Medicaid
8243K6Medicare PIN
TX144498601Medicaid
TXTXB116879Medicare PIN
TX8L0765Medicare PIN