Healthcare Provider Details

I. General information

NPI: 1649565516
Provider Name (Legal Business Name): SARA CASEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA RODENAS-MARTINEZ

II. Dates (important events)

Enumeration Date: 06/18/2011
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 QUEEN ST
WORCESTER MA
01610-2473
US

IV. Provider business mailing address

645 PARK AVE
WORCESTER MA
01603-2034
US

V. Phone/Fax

Practice location:
  • Phone: 508-860-7800
  • Fax: 508-796-7032
Mailing address:
  • Phone: 508-792-7580
  • Fax: 508-753-1682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number258684
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: