Healthcare Provider Details

I. General information

NPI: 1831148907
Provider Name (Legal Business Name): FILISSA M CASERTA C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9106 PHILADELPHIA RD STE 108
ROSEDALE MD
21237-4335
US

IV. Provider business mailing address

9106 PHILADELPHIA RD STE 108
ROSEDALE MD
21237-4335
US

V. Phone/Fax

Practice location:
  • Phone: 410-682-5040
  • Fax:
Mailing address:
  • Phone: 410-682-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR096896
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: