Healthcare Provider Details

I. General information

NPI: 1417675265
Provider Name (Legal Business Name): TESSA ANN CESARIO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/25/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DEPARTMENT OF UROLOGY
MORGANTOWN WV
26506-1200
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DEPARTMENT OF UROLOGY
MORGANTOWN WV
26506-1200
US

V. Phone/Fax

Practice location:
  • Phone: 304-293-2706
  • Fax:
Mailing address:
  • Phone: 304-293-2706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2874
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: