Provider Demographics
NPI:1942275318
Name:PASCHAL-PULLIAM, CYNTHIA R
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:R
Last Name:PASCHAL-PULLIAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-2057
Mailing Address - Country:US
Mailing Address - Phone:724-983-3820
Mailing Address - Fax:724-983-3941
Practice Address - Street 1:2375 GARDEN WAY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-5209
Practice Address - Country:US
Practice Address - Phone:724-983-5454
Practice Address - Fax:724-983-5419
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007983363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169838OtherCIGNA
349241OtherANTHEM BC/BS
PA1551925OtherHIGHMARK BC/BS
P00054892OtherRAILROAD MEDICARE
P97671Medicare UPIN
073009H6TMedicare ID - Type Unspecified