Provider Demographics
NPI:1467503912
Name:CASWICK, MARY ANN L (MD)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:L
Last Name:CASWICK
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 754
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:CA
Mailing Address - Zip Code:94937-0754
Mailing Address - Country:US
Mailing Address - Phone:415-669-7588
Mailing Address - Fax:
Practice Address - Street 1:250 BON AIR RD
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1702
Practice Address - Country:US
Practice Address - Phone:415-507-2545
Practice Address - Fax:415-507-2672
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG244092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G244092Medicare PIN