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Provider Information for 1124081625

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. EDITH SANBORN KASELIS MD

Gender: FEMALE

Individual NPI: 1124081625

Calendar   Last Updated:  2011-10-31
  Certification Date: 

Details

Name Value
NPI 1124081625
Enumeration Date 2006-04-07
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 179 ROUTE 6A
YARMOUTH PORT, MA 02675-1714
United States

Phone: 508-833-0269 | Fax: 508-833-1467
View Map External Link
Primary Practice Address 179 ROUTE 6A
YARMOUTH PORT, MA 02675-1714
United States

Phone: 508-833-0269 | Fax: 508-833-1467
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other HARVARD PILGRIM MA 20844
Other CIGNA MA CIGNA
MEDICAID MA 3106438
Other TUFTS HEALTH PLAN MA 728557
Other BLUE CROSS MA J13603
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 208000000X - Pediatrics MA 75612