Provider Demographics
NPI:1508304833
Name:BEARD, CASSANDRA (DO)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:BEARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 OKATIE CENTER BLVD S STE 210
Mailing Address - Street 2:
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7511
Mailing Address - Country:US
Mailing Address - Phone:843-705-0840
Mailing Address - Fax:
Practice Address - Street 1:40 OKATIE CENTER BLVD S STE 210
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-7511
Practice Address - Country:US
Practice Address - Phone:843-705-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC83716207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program