Provider Demographics
NPI:1417159948
Name:CASSEDY, PAUL FINN (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:FINN
Last Name:CASSEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25226 CABOT RD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5504
Mailing Address - Country:US
Mailing Address - Phone:949-707-0005
Mailing Address - Fax:949-707-5371
Practice Address - Street 1:25226 CABOT RD
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5504
Practice Address - Country:US
Practice Address - Phone:949-707-0005
Practice Address - Fax:949-707-5371
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA061357207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH34744Medicare UPIN
CAW15208Medicare ID - Type Unspecified