Provider Demographics
NPI:1669047866
Name:STOUT, CASSIDY SABRINA (MD)
Entity type:Individual
Prefix:DR
First Name:CASSIDY
Middle Name:SABRINA
Last Name:STOUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E. APPLE ST.
Mailing Address - Street 2:WCHE 7TH FLOOR
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MIAMI VALLEY HOSPITAL
Practice Address - Street 2:1 WYOMING ST.
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45407
Practice Address - Country:US
Practice Address - Phone:937-208-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.251808208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty