Provider Demographics
NPI:1528059706
Name:SERVICE, CASSANDRA V (MD)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:V
Last Name:SERVICE
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 1:777 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-499-8570
Mailing Address - Fax:413-499-8565
Practice Address - Street 1:777 NORTH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-499-8570
Practice Address - Fax:413-499-8565
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204892207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0020652OtherNEIGHBORHOOD HEALTH PLAN
10043384OtherCAPITAL DISTRICT PHP
3148787OtherAETNA
000000022181OtherBMC HEALTH NET PLAN
153355OtherMVP SELECT
MA0102831Medicaid
043517461OtherCHAMPUS
44819OtherHEALTHY START
043517461OtherHCVM FIRST HEALTH
043517461OtherHMC PPO
043517461OtherNO AMERICAN ADMIN
160053244OtherMEDICARE RAILROAD
J22441OtherBLUE SHIELD
26372OtherHEATH NEW ENGLAND
J22441OtherHMO BLUE
043517461OtherCIGNA
043517461OtherGIC INDEMNITY PLAN
131258OtherHARVARD COMM HEALTH
043517461OtherNO AMERICAN ADMIN
MA0102831Medicaid