Provider Demographics
NPI:1508827650
Name:BRIAN A. CASAZZA, M.D., PLC
Entity Type:Organization
Organization Name:BRIAN A. CASAZZA, M.D., PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-293-6363
Mailing Address - Street 1:199 SPOTNAP RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8827
Mailing Address - Country:US
Mailing Address - Phone:434-293-6363
Mailing Address - Fax:434-293-9655
Practice Address - Street 1:199 SPOTNAP RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8827
Practice Address - Country:US
Practice Address - Phone:434-293-6363
Practice Address - Fax:434-293-9655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010541962081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG2090Medicare UPIN