Provider Demographics
NPI:1124118815
Name:CASSIDY-SMITH, TARA N (MD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:N
Last Name:CASSIDY-SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA076258207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0038423Medicaid
NJ2566254OtherUNITED HEALTHCARE
NJ39319OtherUNIVERSITY HEALTH PLAN
NJP3344912OtherOXFORD
NJ01000625100OtherAMERICHOICE
NJ1638938OtherAMERIHEALTH PPO/PA BS
NJ2313536000OtherAMERIHEALTH/KEYSTONE/IBC
NJ3565078OtherAETNA
NJ60007325OtherHORIZON NJ HEALTH
NJP00142075Medicare PIN
NJ2566254OtherUNITED HEALTHCARE
NJ39319OtherUNIVERSITY HEALTH PLAN