Active NPI
Edward William Cassidy, PH.D.
- Psychologist
- Crofton, MD
National Provider Identifier
1295767879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1134
- Practice address
- 2110 Priest Bridge Dr
Suite 4
Crofton, MD 21114-2472 - Phone
- (301) 858-9880
- Fax
- (410) 721-3895
- NPI assigned
- Jul 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1134 | MD | Primary |
Addresses
Primary practice location
2110 Priest Bridge Dr
Suite 4
Crofton, MD 21114-2472
Mailing address
2110 Priest Bridge Dr
Suite 4
Crofton, MD 21114-2472
Phone (301) 858-9880
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1134 | MD | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295767879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2110 PRIEST BRIDGE DR",
"address_2": "SUITE 4",
"city": "CROFTON",
"state": "MD",
"postal_code": "211142472",
"telephone_number": "301-858-9880",
"fax_number": "410-721-3895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2110 PRIEST BRIDGE DR",
"address_2": "SUITE 4",
"city": "CROFTON",
"state": "MD",
"postal_code": "211142472",
"telephone_number": "301-858-9880",
"fax_number": "410-721-3895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CASSIDY",
"first_name": "EDWARD",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MD",
"license": "1134",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crofton, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.