Provider Demographics
NPI:1205002698
Name:O'SHAUGHNESSEY, CARA LEA (DO)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:LEA
Last Name:O'SHAUGHNESSEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:LEA
Other - Last Name:STREFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:855 SPRINGDALE DRIVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2551
Mailing Address - Country:US
Mailing Address - Phone:610-561-6100
Mailing Address - Fax:610-524-0133
Practice Address - Street 1:855 SPRINGDALE DRIVE
Practice Address - Street 2:SUITE 120
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2551
Practice Address - Country:US
Practice Address - Phone:610-561-6100
Practice Address - Fax:610-524-0133
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015084207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102638094 0001Medicaid
PA102638094 0001Medicaid