Provider Demographics
NPI:1376617878
Name:CASERTA, MARIA THERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:THERESA
Last Name:CASERTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-7770
Mailing Address - Country:US
Mailing Address - Phone:813-974-3519
Mailing Address - Fax:813-974-2478
Practice Address - Street 1:12901 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4742
Practice Address - Country:US
Practice Address - Phone:813-974-3519
Practice Address - Fax:813-974-2478
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1001902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280229500Medicaid
FL09130OtherBLUE CROSS BLUE SHIELD
FLD16797Medicare UPIN
FLAI876ZMedicare PIN