Healthcare Provider Details

I. General information

NPI: 1235759184
Provider Name (Legal Business Name): CASEY KATHLEEN PATERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 LITCHFIELD ST STE 201
TORRINGTON CT
06790-6669
US

IV. Provider business mailing address

4100 LAKE DR SE STE 205
GRAND RAPIDS MI
49546-8292
US

V. Phone/Fax

Practice location:
  • Phone: 860-489-7017
  • Fax:
Mailing address:
  • Phone: 616-267-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number86435
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number4301514216
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD488426
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: