Provider Demographics
NPI:1144417627
Name:EVELYN V CASAS MD
Entity Type:Organization
Organization Name:EVELYN V CASAS MD
Other - Org Name:KIDS CHOICE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:V
Authorized Official - Last Name:MELLIJOR-CASAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-353-1123
Mailing Address - Street 1:144 MORGAN ST
Mailing Address - Street 2:#8
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5433
Mailing Address - Country:US
Mailing Address - Phone:203-353-1123
Mailing Address - Fax:203-353-1132
Practice Address - Street 1:144 MORGAN ST
Practice Address - Street 2:#8
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5433
Practice Address - Country:US
Practice Address - Phone:203-353-1123
Practice Address - Fax:203-353-1132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001348871Medicaid