Healthcare Provider Details

I. General information

NPI: 1265896906
Provider Name (Legal Business Name): GARRETT GERARD ARTHUR CASALE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 10/14/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CHARLOIS BLVD
WINSTON SALEM NC
27103-1522
US

IV. Provider business mailing address

1795 PAXTON LN
KERNERSVILLE NC
27284-4021
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-3361
  • Fax:
Mailing address:
  • Phone: 770-617-9627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2022-02901
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: