Provider Demographics
NPI:1689634768
Name:CASELLA, ROBERT R (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:CASELLA
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 1:3100 SPRING FOREST RD STE 130
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-2880
Mailing Address - Country:US
Mailing Address - Phone:919-873-9533
Mailing Address - Fax:844-454-0171
Practice Address - Street 1:555 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506
Practice Address - Country:US
Practice Address - Phone:843-661-6215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75054207L00000X
PAMD036049E207L00000X
SC27295207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00177584OtherRR M'CARE
FLP00207618OtherRR M'CARE
FL230355800Medicaid
FL44556OtherBCBS FL
FL00300220OtherRR M'CARE
FLP00177584OtherRR M'CARE
PA512757U31Medicare PIN
FL44556XMedicare ID - Type UnspecifiedLINK TO M'CARE GRP 34910
FLP00207618OtherRR M'CARE
D75185Medicare UPIN
FL44556WMedicare ID - Type UnspecifiedLINK TO M'CARE GRP 21987