1265597082 NPI number — GARY H. CASSEL, M.D.,P.A.

Table of content: (NPI 1265597082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265597082 NPI number — GARY H. CASSEL, M.D.,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARY H. CASSEL, M.D.,P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RUXTON TOWERS EYE ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265597082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8415 BELLONA LANE
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-828-9270
Provider Business Mailing Address Fax Number:
410-321-0124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8415 BELLONA LANE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-828-9270
Provider Business Practice Location Address Fax Number:
410-321-0124
Provider Enumeration Date:
12/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CASSEL
Authorized Official First Name:
GARY
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-828-9270

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TA0856 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: D24345 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 327591400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: KV69RU . This is a "BCBSMD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: RRMCCA9262 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 281531100 . This is a "MAMD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: CA9262 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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