Healthcare Provider Details

I. General information

NPI: 1265322200
Provider Name (Legal Business Name): COREY ROBERT CAVALIER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 HOSPITAL RD
INDIANA PA
15701-3629
US

IV. Provider business mailing address

53 W LIBERTY ST
HOMER CITY PA
15748-1114
US

V. Phone/Fax

Practice location:
  • Phone: 724-464-7305
  • Fax:
Mailing address:
  • Phone: 724-464-7305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA066805
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA066805
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: