Provider Demographics
NPI:1851567747
Name:HUMBYRD, CASEY JO (MD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:JO
Last Name:HUMBYRD
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:230 W WASHINGTON SQUARE
Mailing Address - Street 2:FARM JOURNAL BUILDING 5TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3500
Mailing Address - Country:US
Mailing Address - Phone:215-829-3668
Mailing Address - Fax:215-829-5002
Practice Address - Street 1:230 W WASHINGTON SQUARE
Practice Address - Street 2:FARM JOURNAL BUILDING 5TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3500
Practice Address - Country:US
Practice Address - Phone:215-829-3668
Practice Address - Fax:215-829-5002
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD471570207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD082010500Medicaid
MDP01390683OtherRAILROAD MC
MD082010500Medicaid