Provider Demographics
NPI:1437153855
Name:CANSLER, CASANDRA L (MD)
Entity type:Individual
Prefix:
First Name:CASANDRA
Middle Name:L
Last Name:CANSLER
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:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-0301
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:SUITE H
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28697207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3150573OtherBLUECROSS BLUESHIELD TN
TN3819039Medicaid
3819039Medicare ID - Type UnspecifiedINDIV MEDICARE #
TNG84991Medicare UPIN
TN3819039Medicaid