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General NPI Number Information
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NPI Number | 1689674913
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Entity Type | Individual
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Provider Name | CHARLES L CASSADY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13221 RAVENNA RD
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City | CHARDON
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State | OH
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Zip | 44024-9047
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Country | US
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Telephone | 440-286-9421
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Fax | 440-286-9431
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Provider Business Mailing Address
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Address Line | PO BOX 567
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City | CHAGRIN FALLS
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State | OH
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Zip | 44022-0567
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Country | US
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Telephone | 216-464-5160
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Fax | 216-464-5982
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 35025025
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License Number State | OH
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