Healthcare Provider Details

I. General information

NPI: 1295609535
Provider Name (Legal Business Name): MARISSA LEEANN CUPP PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 CRISSWILL RD
SAINT CLAIRSVILLE OH
43950-1415
US

IV. Provider business mailing address

151 CRISSWILL RD
SAINT CLAIRSVILLE OH
43950-1415
US

V. Phone/Fax

Practice location:
  • Phone: 740-359-0218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: