Provider Demographics
NPI:1649705054
Name:TANNER, CASSANDRE (DO)
Entity type:Individual
Prefix:
First Name:CASSANDRE
Middle Name:
Last Name:TANNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ANCHOR DR STE 201
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-3845
Mailing Address - Country:US
Mailing Address - Phone:207-301-5900
Mailing Address - Fax:
Practice Address - Street 1:7 MADELYN LN # 200
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4460
Practice Address - Country:US
Practice Address - Phone:207-301-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-23
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELT20078207Q00000X
MEDO3132207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine