Basic Information
| Provider Information | |||||||||
| NPI: | 1124118815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASSIDY-SMITH | ||||||||
| FirstName: | TARA | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 FEDERAL ST # 200 | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563564924 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 COOPER PLZ | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563422351 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 06/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MA076258 | NJ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0038423 | 05 | NJ | MEDICAID | 2566254 | 01 | NJ | UNITED HEALTHCARE | OTHER | 39319 | 01 | NJ | UNIVERSITY HEALTH PLAN | OTHER | P3344912 | 01 | NJ | OXFORD | OTHER | 01000625100 | 01 | NJ | AMERICHOICE | OTHER | 1638938 | 01 | NJ | AMERIHEALTH PPO/PA BS | OTHER | 2313536000 | 01 | NJ | AMERIHEALTH/KEYSTONE/IBC | OTHER | 3565078 | 01 | NJ | AETNA | OTHER | 60007325 | 01 | NJ | HORIZON NJ HEALTH | OTHER |