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NPI Code Detail

MEDICARE: MICHAEL CASSELLA

MEDICARE: MICHAEL CASSELLA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1255941738
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL CASSELLA
Provider Business Mailing Address
First Line : 243 MAYFLOWER DR
Second Line :
City : MANCHESTER
State : NH
Zip : 03104-2820
Country : US
Telephone Number : 603-459-9922
Fax Number :
Provider Business Practice Location Address
First Line : 1260 ELM ST
Second Line :
City : MANCHESTER
State : NH
Zip : 03101-1305
Country : US
Telephone Number : 603-314-1701
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2020
Last Update Date : 08/09/2020

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Directions to “ MICHAEL CASSELLA ” Practice Location

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