Provider Demographics
NPI:1154332088
Name:CASANOVA, MARK ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:CASANOVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 605
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-820-9248
Mailing Address - Fax:214-820-9458
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:SUITE 605
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-820-9248
Practice Address - Fax:214-820-9458
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6008207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158443501Medicaid
TX8G0891OtherBCBS
TX158443502Medicaid
TXP00012554Medicare PIN
TX158443501Medicaid
TX158443502Medicaid
TX8A5743Medicare PIN
TXH81287Medicare UPIN