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NPI Code Detail

MEDICARE: DR. EDDA CASANOVA MD

MEDICARE: DR. EDDA CASANOVA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0804XChild & Adolescent Psychiatry PhysicianME96720FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215922695
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDDA CASANOVA MD
Provider Business Mailing Address
First Line : 201 W PLYMOUTH AVE
Second Line :
City : DELAND
State : FL
Zip : 32720-2753
Country : US
Telephone Number : 386-873-2963
Fax Number : 386-873-2786
Provider Business Practice Location Address
First Line : 201 W PLYMOUTH AVE
Second Line :
City : DELAND
State : FL
Zip : 32720-2753
Country : US
Telephone Number : 386-873-2963
Fax Number : 386-873-2786
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2005
Last Update Date : 02/26/2013

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