Provider Demographics
NPI:1578764684
Name:PRENGER, CASEY LEE (MD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:LEE
Last Name:PRENGER
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:PO BOX 149
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0149
Mailing Address - Country:US
Mailing Address - Phone:828-339-9163
Mailing Address - Fax:828-586-8209
Practice Address - Street 1:68 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-2722
Practice Address - Country:US
Practice Address - Phone:828-586-7428
Practice Address - Fax:828-586-7427
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57010017207R00000X
NC200901153207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP01685425OtherRR MEDICARE
NC2076595Medicare PIN
NCBCJ690AMedicare PIN