Provider Demographics
NPI:1538554019
Name:CASSEDAY, RACHEL ELENA (DO)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ELENA
Last Name:CASSEDAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:ELENA
Other - Last Name:CULLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5159 SABRINA LN NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-1281
Mailing Address - Country:US
Mailing Address - Phone:330-979-1057
Mailing Address - Fax:
Practice Address - Street 1:667 EASTLAND AVE SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4503
Practice Address - Country:US
Practice Address - Phone:330-841-2378
Practice Address - Fax:330-729-1591
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013300207Q00000X
OH58.005929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0139878Medicaid