Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 11251 | WV |
NPI | 1063523512 |
---|---|
Provider Name | Nicholas Cassis JR. |
First Address | Charleston, WV 25301-1842 |
Second Address | Charleston, WV 25301-1842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B42542 | (02) | WV |