Provider Demographics
NPI:1568939718
Name:TOLSON, CASSANDRA LENORA
Entity Type:Individual
Prefix:PROF
First Name:CASSANDRA
Middle Name:LENORA
Last Name:TOLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-5710
Mailing Address - Country:US
Mailing Address - Phone:240-346-6043
Mailing Address - Fax:
Practice Address - Street 1:7330 HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5710
Practice Address - Country:US
Practice Address - Phone:240-346-6043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR4329P251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD09-0939305Medicaid