Provider Demographics
NPI:1023422656
Name:DIELWART, CASSANDRA LANE (MD)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:LANE
Last Name:DIELWART
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 1:3114 TURNER STREET
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:BC
Mailing Address - Zip Code:V5K2H1
Mailing Address - Country:CA
Mailing Address - Phone:778-960-9765
Mailing Address - Fax:
Practice Address - Street 1:1320 SCOTT AVE
Practice Address - Street 2:DEPARTMENT OF ORTHOPAEDIC SURGERY- TRAUMA
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2918
Practice Address - Country:US
Practice Address - Phone:704-355-6046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01045282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital