Provider Demographics
NPI:1376734343
Name:CASEY, RENEE C (MD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:C
Last Name:CASEY
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 1:31 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-3917
Mailing Address - Country:US
Mailing Address - Phone:203-687-6311
Mailing Address - Fax:
Practice Address - Street 1:88 NOBLE AVE STE 101
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4738
Practice Address - Country:US
Practice Address - Phone:203-874-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1.048749208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics