MEDICARE: VINCENT O. CASIBANG, M.D., P.A.

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
1	174400000X	Specialist	D0023927	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4051226	OTHER	MD	AETNA USHC TRADITIONAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	82716	OTHER	MD	AETNA HMO
4	24311	OTHER	MD	MAMSI/OPTIMUM PROVIDER #
5	98920001	OTHER	MD	BCBS NCA
6	9892	OTHER	MD	CAPITAL CARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	327264	OTHER	MD	PRIME HEALTH
9	94912	OTHER	MD	HEALTH PARTNERS
10	02244 VO02	OTHER	MD	BCBS MD
11	67535	OTHER	MD	AMERIGROUP PROVIDER #

General Provider Information

NPI Number	:	1710940309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINCENT O. CASIBANG, M.D., P.A.

Provider Business Mailing Address
First Line	:	PO BOX 886
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20703-0886
Country	:	US
Telephone Number	:	301-731-5944
Fax Number	:	301-731-9034

Provider Business Practice Location Address
First Line	:	9470 ANNAPOLIS RD
Second Line	:	SUITE 307
City	:	LANHAM
State	:	MD
Zip	:	20706-3025
Country	:	US
Telephone Number	:	301-731-5944
Fax Number	:	301-731-9034

Authorized Official
Title or Position	:	CORPORATE PRESIDENT
Name	:	VINCENT ONATE CASIBANG
Credential	:	M.D.
Telephone Number	:	301-731-5744

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	08/22/2020

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