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General NPI Number Information
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NPI Number | 1013954387
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Entity Type | Organization
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Legal Business Name | NEUROSURGICAL ASSOCIATES CASSIDY & GUERIN, MD, PA
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 842 SUNSET LAKE BLVD SUITE 302
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City | VENICE
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State | FL
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Zip | 34292-7552
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Country | US
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Telephone | 941-484-3404
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Fax | 941-496-7895
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Provider Business Mailing Address
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Address Line | 842 SUNSET LAKE BLVD SUITE 302
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City | VENICE
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State | FL
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Zip | 34292-7552
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Country | US
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Telephone | 941-484-3404
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Fax | 941-496-7895
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Authorized Official
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Title or Position | SURGEON
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Name | DR. JOHN R CASSIDY
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Credential | M.D.
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Telephone | 941-484-3404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | ME78002
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | ME0057567
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License Number State | VA
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