Provider Demographics
NPI:1609507227
Name:MASSICOTTE, CASSIE RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:RENEE
Last Name:MASSICOTTE
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 1:504 FORT EVANS RD STE 204
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4097
Mailing Address - Country:US
Mailing Address - Phone:703-737-3500
Mailing Address - Fax:
Practice Address - Street 1:504 FORT EVANS RD STE 204
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4097
Practice Address - Country:US
Practice Address - Phone:135-445-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0110009641363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program