Provider Demographics
NPI:1245049667
Name:CASINI, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CASINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 FAIRFAX DR APT 1131
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-4495
Mailing Address - Country:US
Mailing Address - Phone:401-499-4439
Mailing Address - Fax:
Practice Address - Street 1:3444 FAIRFAX DR APT 1131
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-4495
Practice Address - Country:US
Practice Address - Phone:401-499-4439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP031233363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics