Provider Demographics
NPI:1578561940
Name:CASAZZA, BRIAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:A
Last Name:CASAZZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 SPOTNAP RD
Mailing Address - Street 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:STE 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
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
VA0101054196174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG29010Medicare UPIN