Provider Demographics
NPI:1710645833
Name:MOORE, CASSIDY (PA)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 VALLEYVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SCENERY HILL
Mailing Address - State:PA
Mailing Address - Zip Code:15360-1001
Mailing Address - Country:US
Mailing Address - Phone:724-678-8861
Mailing Address - Fax:
Practice Address - Street 1:3840 WASHINGTON RD STE 300
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2919
Practice Address - Country:US
Practice Address - Phone:724-941-3273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2022-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA063114363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant