Provider Demographics
NPI:1477578540
Name:CASEY, DENISE WINIFRED ANN (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:WINIFRED ANN
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 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 777
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-2981
Mailing Address - Fax:585-273-1039
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 777
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-2981
Practice Address - Fax:585-273-1039
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235874208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02666782Medicaid
NY5330QC / 002BBFMedicare ID - Type Unspecified
NY02666782Medicaid