Provider Demographics
NPI:1205890308
Name:CASEY, MARTIN A (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:A
Last Name:CASEY
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 1:290 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1945
Mailing Address - Country:US
Mailing Address - Phone:716-675-7693
Mailing Address - Fax:855-714-1253
Practice Address - Street 1:290 CENTER RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1945
Practice Address - Country:US
Practice Address - Phone:716-675-7693
Practice Address - Fax:855-714-1253
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190108207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01358974Medicaid
NY190108OtherNYS LICENSE
NYF42568Medicare UPIN
NYAA0715Medicare PIN