Provider Demographics
NPI:1477794428
Name:PAMELA W. CASSON, MD, PC
Entity type:Organization
Organization Name:PAMELA W. CASSON, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:CASSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-598-0631
Mailing Address - Street 1:5605 COACHWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-4454
Mailing Address - Country:US
Mailing Address - Phone:719-598-0631
Mailing Address - Fax:
Practice Address - Street 1:1465 KELLY JOHNSON BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3955
Practice Address - Country:US
Practice Address - Phone:719-265-1050
Practice Address - Fax:719-265-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO85487210Medicaid