Provider Demographics
NPI:1710940309
Name:VINCENT O. CASIBANG, M.D., P.A.
Entity Type:Organization
Organization Name:VINCENT O. CASIBANG, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:ONATE
Authorized Official - Last Name:CASIBANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-731-5744
Mailing Address - Street 1:PO BOX 886
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20703-0886
Mailing Address - Country:US
Mailing Address - Phone:301-731-5944
Mailing Address - Fax:301-731-9034
Practice Address - Street 1:9470 ANNAPOLIS RD
Practice Address - Street 2:SUITE 307
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3025
Practice Address - Country:US
Practice Address - Phone:301-731-5944
Practice Address - Fax:301-731-9034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023927174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4051226OtherAETNA USHC TRADITIONAL
VA73 0339 4Medicaid
MD82716OtherAETNA HMO
MD24311OtherMAMSI/OPTIMUM PROVIDER #
MD98920001OtherBCBS NCA
MD9892OtherCAPITAL CARE
DC0412120(023267500)Medicaid
MD327264OtherPRIME HEALTH
MD94912OtherHEALTH PARTNERS
MD02244 VO02OtherBCBS MD
MD67535OtherAMERIGROUP PROVIDER #
MD24311OtherMAMSI/OPTIMUM PROVIDER #
VA73 0339 4Medicaid
MD327264OtherPRIME HEALTH