Provider Demographics
NPI:1154422137
Name:CASSIS, ANITA (MD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:CASSIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 226TH PL SE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8969
Mailing Address - Country:US
Mailing Address - Phone:425-392-8611
Mailing Address - Fax:425-392-9012
Practice Address - Street 1:6520 226TH PL SE
Practice Address - Street 2:SUITE 205
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8969
Practice Address - Country:US
Practice Address - Phone:425-392-8611
Practice Address - Fax:425-392-9012
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023184174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00429699OtherRAILROAD MEDICARE
WA6525CAOtherREGENCE
WA8864120Medicare PIN
WAE53805Medicare UPIN