Individual
TEHAN C CUSIMANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
407 MAIN ST, SPENCER, MA 01562
(508) 885-9737
(508) 885-6139
Mailing address
630 PLANTATION ST, WORCESTER, MA 01605
(508) 885-9737
(508) 885-6189
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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