Provider Demographics
NPI:1619647138
Name:LANDRY, EVIE CASSANDRA (MD, FRCSC)
Entity Type:Individual
Prefix:DR
First Name:EVIE
Middle Name:CASSANDRA
Last Name:LANDRY
Suffix:
Gender:F
Credentials:MD, FRCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 M ST NW APT 906
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-4229
Mailing Address - Country:US
Mailing Address - Phone:202-568-4304
Mailing Address - Fax:
Practice Address - Street 1:CHILDRENS NATIONAL HOSPITAL- DIVISION OF OTOLARYNGOLOGY
Practice Address - Street 2:111 MICHIGAN AVENUE NW SUITE 3W-800
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-476-3659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMTL500001531207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Single Specialty