Provider Demographics
NPI:1194739326
Name:CASHMAN, CORY LYLE (MD)
Entity type:Individual
Prefix:DR
First Name:CORY
Middle Name:LYLE
Last Name:CASHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 MEDICAL CENTER BLVD
Mailing Address - Street 2:STE N411
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3187
Mailing Address - Country:US
Mailing Address - Phone:504-328-5703
Mailing Address - Fax:
Practice Address - Street 1:1111 MEDICAL CENTER BLVD
Practice Address - Street 2:STE N411
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3187
Practice Address - Country:US
Practice Address - Phone:504-328-5703
Practice Address - Fax:504-328-5706
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017542207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1363774Medicaid
B89237Medicare UPIN
5M354Medicare ID - Type Unspecified