Individual
CASEY R SANSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
420 HILLCREST AVE, GROVE CITY, PA 16127-1708
(724) 458-4950
(724) 458-4822
Mailing address
420 HILLCREST AVE, GROVE CITY, PA 16127-1708
(724) 458-4950
(724) 458-4822
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA052529
PA
363AM0700X
Medical Physician Assistant
MA052529
PA
363AM0700X
Medical Physician Assistant
OA000909
PA
363AS0400X
Surgical Physician Assistant
MA052529
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103205962
—
PA
Enumeration date
11/29/2006
Last updated
01/25/2024
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