Provider Demographics
NPI:1427269331
Name:CASSELL, MATTHEW WADE (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WADE
Last Name:CASSELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1704 23RD AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-3103
Mailing Address - Country:US
Mailing Address - Phone:601-482-1555
Mailing Address - Fax:601-696-4608
Practice Address - Street 1:1704 23RD AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3103
Practice Address - Country:US
Practice Address - Phone:601-482-1555
Practice Address - Fax:601-696-4608
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20329174400000X, 207RH0003X
MS305867207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS009300810Medicaid
MS302I832404Medicare PIN
MS264730YJ5WMedicare PIN