Provider Demographics
NPI:1760672489
Name:MIERISCH, CASSANDRA (M D)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:
Last Name:MIERISCH
Suffix:
Gender:F
Credentials:M D
Other - Prefix:DR
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M D
Mailing Address - Street 1:2331 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1111
Mailing Address - Country:US
Mailing Address - Phone:540-725-1226
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:2331 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242071207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1760672489OtherUNITED HEALTHCARE
VA1760672489OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1760672489OtherHUMANA MEDICARE
VA1760672489OtherVIRGINIA HEALTH NETWORK
VA1760672489OtherHEALTHKEEPERS
VA371194700OtherBLACK LUNG
VA540506332004OtherTRICARE
VA1760672489OtherUMWA
VA1760672489Medicaid
VA1760672489OtherINTOTAL
VA761760OtherMEDICAID OF NORTH CAROLINA
VA1760672489OtherAETNA
VA1760672489OtherANTHEM
VA1760672489OtherCIGNA
VA1760672489OtherVIRGINIA PREMIER
VA1760672489OtherHEALTHKEEPERS PLUS
VA1760672489OtherOPTIMA HEALTH PLAN
VA1760672489OtherGATEWAY
VA3810010540OtherMEDICAID OF WVA
VAP00450222OtherRAILROAD MEDICARE
VA1760672489Medicaid
VA1760672489Medicaid