Healthcare Provider Details

I. General information

NPI: 1043251572
Provider Name (Legal Business Name): MEREDITH S. CASSIDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 E WOODMEN RD SUITE 405
COLORADO SPRINGS CO
80923-2607
US

IV. Provider business mailing address

6071 E WOODMEN RD SUITE 405
COLORADO SPRINGS CO
80923-2607
US

V. Phone/Fax

Practice location:
  • Phone: 719-442-0808
  • Fax:
Mailing address:
  • Phone: 719-442-0808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberDR.0040019
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number40019
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: