Provider Demographics
NPI:1548791023
Name:FEIN, CASEY I (MD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:I
Last Name:FEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:I
Other - Last Name:FEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:193 LOCUST ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2056
Practice Address - Country:US
Practice Address - Phone:413-584-8700
Practice Address - Fax:413-584-1714
Is Sole Proprietor?:No
Enumeration Date:2017-03-25
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA283574208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110126411AMedicaid