Provider Demographics
NPI:1669597357
Name:CASANDRA L. CANSLER, MD, PC
Entity type:Organization
Organization Name:CASANDRA L. CANSLER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CASANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CANSLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-332-8634
Mailing Address - Street 1:PO BOX 11443
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-2443
Mailing Address - Country:US
Mailing Address - Phone:423-332-8633
Mailing Address - Fax:423-332-8634
Practice Address - Street 1:8804 DAYTON PIKE
Practice Address - Street 2:
Practice Address - City:SODDY DAISY
Practice Address - State:TN
Practice Address - Zip Code:37379-4306
Practice Address - Country:US
Practice Address - Phone:423-332-8633
Practice Address - Fax:423-332-8634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3819036Medicaid
G84991OtherUPIN
3819036Medicare ID - Type Unspecified