Provider Demographics
NPI:1639231673
Name:CARBERRY, CASSANDRA LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:LEIGH
Last Name:CARBERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PLAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4829
Mailing Address - Country:US
Mailing Address - Phone:917-749-0634
Mailing Address - Fax:
Practice Address - Street 1:101 PLAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4829
Practice Address - Country:US
Practice Address - Phone:401-453-7560
Practice Address - Fax:401-453-7573
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239751207V00000X
RICMD13051207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology