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General NPI Number Information
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NPI Number | 1649705054
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Entity Type | Individual
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Provider Name | CASSANDRE TANNER D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/23/2017
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 7 MADELYN LN # 200
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City | ROCKPORT
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State | ME
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Zip | 04856-4460
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Country | US
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Telephone | 207-301-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 15 ANCHOR DR STE 201
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City | ROCKPORT
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State | ME
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Zip | 04856-3845
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Country | US
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Telephone | 207-301-5900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | LT20078
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO3132
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License Number State | ME
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