Healthcare Provider Details

I. General information

NPI: 1780594952
Provider Name (Legal Business Name): KASSIDY MARIE OAKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W FAYETTE ST STE 300
BALTIMORE MD
21201-1756
US

IV. Provider business mailing address

344 GRAY DR
LUSBY MD
20657-4105
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-5242
  • Fax:
Mailing address:
  • Phone: 410-474-7548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: