Provider Demographics
NPI:1164472536
Name:MCCASLIN, ROBERT I (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:I
Last Name:MCCASLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:505 ELLIS BLVD APT A5
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-2291
Mailing Address - Country:US
Mailing Address - Phone:858-735-6943
Mailing Address - Fax:
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:PSSB SUITE 2100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-8249
Practice Address - Fax:916-734-7950
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2014-07-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA226294208000000X, 2080P0204X
CAG79591208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2110415Medicaid
A39118Medicare ID - Type Unspecified
C79112Medicare UPIN