MEDICARE: CASEY O'DONNELL D.O., MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	25MB07680200	NJ
2	208100000X	Physical Medicine & Rehabilitation Physician	OS013626	PA
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	DO00614	RI
4	208VP0014X	Interventional Pain Medicine Physician	DO00614	RI
5	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	OS11404	FL
6	208100000X	Physical Medicine & Rehabilitation Physician	234536	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922062157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY O'DONNELL D.O., MBA

Provider Business Mailing Address
First Line	:	62 13TH ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02129-2056
Country	:	US
Telephone Number	:	617-952-5299
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 POND PARK RD STE 303
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-4354
Country	:	US
Telephone Number	:	781-624-2525
Fax Number	:	781-741-6297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	12/15/2024

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Directions to “ CASEY O'DONNELL D.O., MBA” Practice Location

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