Provider Demographics
NPI:1649746801
Name:RULLMAN, CASSANDRA L (PA-C)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:L
Last Name:RULLMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 STONE POINT DR UNIT 324
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-6992
Mailing Address - Country:US
Mailing Address - Phone:410-570-6337
Mailing Address - Fax:
Practice Address - Street 1:5530 WISCONSIN AVE STE 1418
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4302
Practice Address - Country:US
Practice Address - Phone:301-986-1880
Practice Address - Fax:301-718-7372
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9454363A00000X
MDC0008820363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant