Healthcare Provider Details

I. General information

NPI: 1457200511
Provider Name (Legal Business Name): CASSANDRA MARIE KUCHINSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1590
US

IV. Provider business mailing address

604 ROCKWOOD DR
ELIZABETHTOWN PA
17022-1255
US

V. Phone/Fax

Practice location:
  • Phone: 800-492-5538
  • Fax:
Mailing address:
  • Phone: 570-573-7974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR276127
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: