Healthcare Provider Details

I. General information

NPI: 1821058413
Provider Name (Legal Business Name): SUSAN BLEASDALE CASEY M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN CASEY BLEASDALE M.D.

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 W JEFFERSON BLVD
FORT WAYNE IN
46804-4160
US

IV. Provider business mailing address

110 S PACA ST # 6N406
BALTIMORE MD
21201-1642
US

V. Phone/Fax

Practice location:
  • Phone: 260-435-7001
  • Fax:
Mailing address:
  • Phone: 410-328-1580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01099550A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberD0101485
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036109313
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: