Provider Demographics
NPI:1285928440
Name:CORDLE, ASA LEE (MD)
Entity type:Individual
Prefix:
First Name:ASA
Middle Name:LEE
Last Name:CORDLE
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 1:3900 BROWNING PL STE 201
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6530
Mailing Address - Country:US
Mailing Address - Phone:919-787-7125
Mailing Address - Fax:919-781-9952
Practice Address - Street 1:3900 BROWNING PL STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6530
Practice Address - Country:US
Practice Address - Phone:919-787-7125
Practice Address - Fax:919-781-9952
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-017172084P0800X
NC172698390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program