Provider Demographics
NPI:1225588460
Name:CUSHMA, KATHARINE DARIA (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:DARIA
Last Name:CUSHMA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TRICH DR STE 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-5990
Mailing Address - Country:US
Mailing Address - Phone:724-225-8657
Mailing Address - Fax:724-228-8388
Practice Address - Street 1:100 TRICH DR STE 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-5990
Practice Address - Country:US
Practice Address - Phone:724-225-8657
Practice Address - Fax:724-228-8388
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058593363AM0700X
PAOA003928363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical