Healthcare Provider Details

I. General information

NPI: 1962488692
Provider Name (Legal Business Name): JOHN P CASEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 RUSSELL AVE
GAITHERSBURG MD
20877-2800
US

IV. Provider business mailing address

201 RUSSELL AVE
GAITHERSBURG MD
20877-2800
US

V. Phone/Fax

Practice location:
  • Phone: 301-468-1995
  • Fax: 301-468-1994
Mailing address:
  • Phone: 301-468-1995
  • Fax: 301-468-1994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberD0043243
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberD0043243
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: