Provider Demographics
NPI:1053309716
Name:CASEY, JEROME P (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:P
Last Name:CASEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ARCHBALD
Mailing Address - State:PA
Mailing Address - Zip Code:18403-2101
Mailing Address - Country:US
Mailing Address - Phone:570-876-1440
Mailing Address - Fax:570-876-0556
Practice Address - Street 1:401 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ARCHBALD
Practice Address - State:PA
Practice Address - Zip Code:18403-2101
Practice Address - Country:US
Practice Address - Phone:570-876-1440
Practice Address - Fax:570-876-0556
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-002702 L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT30293Medicare UPIN
PA4364090001Medicare NSC
PA4364090001Medicare NSC