Healthcare Provider Details

I. General information

NPI: 1760672489
Provider Name (Legal Business Name): CASSANDRA MIERISCH M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSANDRA ROBERTSON M. D.

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 FRANKLIN RD SW
ROANOKE VA
24014-1111
US

IV. Provider business mailing address

2331 FRANKLIN RD SW
ROANOKE VA
24014-1111
US

V. Phone/Fax

Practice location:
  • Phone: 540-725-1226
  • Fax: 540-857-5306
Mailing address:
  • Phone: 540-725-1226
  • Fax: 540-857-5306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101242071
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number0101242071
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: