Provider Demographics
NPI:1912979386
Name:CASSANDRA, MARYA L (DO)
Entity Type:Individual
Prefix:DR
First Name:MARYA
Middle Name:L
Last Name:CASSANDRA
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 1:1047 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3379
Mailing Address - Country:US
Mailing Address - Phone:614-777-1200
Mailing Address - Fax:
Practice Address - Street 1:3853 TRUEMAN CT
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-2496
Practice Address - Country:US
Practice Address - Phone:614-777-1200
Practice Address - Fax:614-777-1294
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009168207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCA4261281Medicare PIN