Healthcare Provider Details

I. General information

NPI: 1750540571
Provider Name (Legal Business Name): CASEY ELDERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1272 W MAIN RD
MIDDLETOWN RI
02842-6405
US

IV. Provider business mailing address

50 MEMORIAL BLVD
NEWPORT RI
02840-3636
US

V. Phone/Fax

Practice location:
  • Phone: 401-847-2900
  • Fax: 401-849-8446
Mailing address:
  • Phone: 401-847-2290
  • Fax: 401-849-8446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD13630
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: