Basic Information
| Provider Information | |||||||||
| NPI: | 1710645833 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | CASSIDY | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 VALLEYVIEW RD | ||||||||
| Address2: | |||||||||
| City: | SCENERY HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153601001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7246788861 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3840 WASHINGTON RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | MC MURRAY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153172919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249413273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2021 | ||||||||
| LastUpdateDate: | 11/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA063114 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.