Provider Demographics
NPI:1568230019
Name:CASSIDY, PEYTON MARION (PA-C)
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:MARION
Last Name:CASSIDY
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 1:7028 CLINTON CT
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-7601
Mailing Address - Country:US
Mailing Address - Phone:443-813-0172
Mailing Address - Fax:
Practice Address - Street 1:7028 CLINTON CT
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-7601
Practice Address - Country:US
Practice Address - Phone:443-813-0172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical