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Individual

TEHAN C CUSIMANO

Active
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Individual

TEHAN C CUSIMANO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1462
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042472266
THREE RIVERS
—
01
—
043058466002
TRICARE CHAMPUS
—
01
—
57118
FALLON COMM. HEALTH PLAN
—
01
—
8301421
EVERCARE
—
01
—
AP1906
MEDICARE B
—
01
—
P00005836
RAILROAD MEDICARE
—
Enumeration date
01/10/2006
Last updated
04/08/2009
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