Individual
EZEQUIEL HERNAN CASSINELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5505 PEACHTREE DUNWOODY RD NE, SUITE 600, ATLANTA, GA 30342-1705
(404) 355-0743
(404) 943-0641
Mailing address
2001 PEACHTREE RD NE, SUITE 705, ATLANTA, GA 30309-1476
(404) 355-0743
(404) 355-2136
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
059053
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000503683
ANTHEM
—
01
—
0486290001
DME
—
01
—
203287
UNISON
—
05
—
2409521
—
OH
01
—
7848618
AETNA
—
01
—
P00242139
RAILROAD MEDICARE
OH
01
—
P00364266
MCR RR
—
Enumeration date
07/12/2006
Last updated
10/22/2010
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