Healthcare Provider Details

I. General information

NPI: 1922062157
Provider Name (Legal Business Name): CASEY O'DONNELL D.O., MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 12/15/2024
Certification Date: 12/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 POND PARK RD STE 303
HINGHAM MA
02043-4354
US

IV. Provider business mailing address

62 13TH ST
BOSTON MA
02129-2056
US

V. Phone/Fax

Practice location:
  • Phone: 781-624-2525
  • Fax: 781-741-6297
Mailing address:
  • Phone: 617-952-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MB07680200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOS013626
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberDO00614
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberDO00614
License Number StateRI
# 5
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS11404
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number234536
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: