Provider Demographics
NPI:1568175693
Name:BARTLETT, CASEY
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062
Mailing Address - Country:US
Mailing Address - Phone:413-586-8400
Mailing Address - Fax:866-644-0872
Practice Address - Street 1:70 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062
Practice Address - Country:US
Practice Address - Phone:413-586-8400
Practice Address - Fax:866-644-0872
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA100471363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant