Healthcare Provider Details

I. General information

NPI: 1184791261
Provider Name (Legal Business Name): ALEXANDRA CASSOTTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 TANEY AVE STE 201
FREDERICK MD
21702-4747
US

IV. Provider business mailing address

1475 TANEY AVE STE 201
FREDERICK MD
21702-4747
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-1930
  • Fax: 240-379-6710
Mailing address:
  • Phone: 301-662-0133
  • Fax: 240-379-6710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0067590
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: