Healthcare Provider Details

I. General information

NPI: 1952328999
Provider Name (Legal Business Name): JOAN CASSETTARI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 PLEASANT ST
CONCORD NH
03301-7560
US

IV. Provider business mailing address

253 PLEASANT ST
CONCORD NH
03301-7560
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-4548
  • Fax:
Mailing address:
  • Phone: 603-228-4548
  • Fax: 603-229-5233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number7605
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: