MEDICARE: DR. JESSICA KAMALINI CASSADY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	MT187691	PA
2	207R00000X	Internal Medicine Physician	35.098207	OH

General Provider Information

NPI Number	:	1083807762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA KAMALINI CASSADY M.D.

Provider Business Mailing Address
First Line	:	2753 ERIE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-2204
Country	:	US
Telephone Number	:	513-246-8000
Fax Number	:	513-871-2824

Provider Business Practice Location Address
First Line	:	2753 ERIE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-2204
Country	:	US
Telephone Number	:	513-246-8000
Fax Number	:	513-871-2824

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2007
Last Update Date	:	11/14/2022

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