Provider Demographics
NPI:1033316641
Name:CASASCO, JULIE FRITZ (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:FRITZ
Last Name:CASASCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:FRITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1369 SCOTTS CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4783
Mailing Address - Country:US
Mailing Address - Phone:513-300-5301
Mailing Address - Fax:
Practice Address - Street 1:3337 BUSINESS CIR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-7415
Practice Address - Country:US
Practice Address - Phone:843-640-0068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC299885Medicaid
SCP01157488Medicare PIN
SCAA59617126Medicare PIN