Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | D0043243 | MD |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | D0043243 | MD |
NPI | 1962488692 |
---|---|
Provider Name | Dr. John P Casey |
First Address | Gaithersburg, MD 20877-2800 |
Second Address | Gaithersburg, MD 20877-2800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 31/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
216651800 | (05) | MD |
E02138 | (02) | MD |