Provider Demographics
NPI:1508058017
Name:BRANDON, CASSANDRA DENISE (MD)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:DENISE
Last Name:BRANDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:PLUMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2600 BELLE CHASSE HWY
Mailing Address - Street 2:B-2
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7156
Mailing Address - Country:US
Mailing Address - Phone:504-349-2273
Mailing Address - Fax:504-349-6160
Practice Address - Street 1:2600 BELLE CHASSE HWY
Practice Address - Street 2:B-2
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-7156
Practice Address - Country:US
Practice Address - Phone:504-349-2273
Practice Address - Fax:504-349-6160
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204008207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1161209Medicaid
LA4P137Medicare PIN