Healthcare Provider Details

I. General information

NPI: 1497788673
Provider Name (Legal Business Name): CHARLES D. CASAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 05/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BEHAVIORAL HEALTH CENTER CMC RANDOLPH 501 BILLINGSLEY ROAD
CHARLOTTE NC
28211-1009
US

IV. Provider business mailing address

BEHAVIORAL HEALTH CENTER CMC RANDOLPH 501 BILLINGSLEY ROAD
CHARLOTTE NC
28211-1009
US

V. Phone/Fax

Practice location:
  • Phone: 704-358-2700
  • Fax: 704-358-2945
Mailing address:
  • Phone: 704-358-2710
  • Fax: 704-358-2938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number9401147
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9401147
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7921553
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier21553
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: