Provider Demographics
NPI:1962488692
Name:CASEY, JOHN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:CASEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:201 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2800
Mailing Address - Country:US
Mailing Address - Phone:301-468-1995
Mailing Address - Fax:301-468-1994
Practice Address - Street 1:201 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2800
Practice Address - Country:US
Practice Address - Phone:301-468-1995
Practice Address - Fax:301-468-1994
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0043243204C00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD216651800Medicaid
MD216651800Medicaid
MDE02138Medicare UPIN