Healthcare Provider Details

I. General information

NPI: 1952833410
Provider Name (Legal Business Name): CASSANDRA A LAW D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 LENDEW ST
GREENSBORO NC
27408-7007
US

IV. Provider business mailing address

1908 LENDEW ST
GREENSBORO NC
27408-7007
US

V. Phone/Fax

Practice location:
  • Phone: 336-273-2835
  • Fax:
Mailing address:
  • Phone: 336-273-2835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number202101524
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: