Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 0101-053359 | VA |
NPI | 1033170659 |
---|---|
Provider Name | Dr. Robert E Cassidy |
First Address | Martinsville, VA 24112-1945 |
Second Address | Martinsville, VA 24112-1945 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 16/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033170659 | (05) | VA |
A40146 | (02) | VA |