Provider Demographics
NPI:1396776480
Name:CASANO, ROSALIE A (MD)
Entity type:Individual
Prefix:DR
First Name:ROSALIE
Middle Name:A
Last Name:CASANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 LAKELAND DR
Mailing Address - Street 2:#B, SUITE 1040
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8839
Mailing Address - Country:US
Mailing Address - Phone:601-955-3388
Mailing Address - Fax:
Practice Address - Street 1:3531 LAKELAND DR
Practice Address - Street 2:#B, SUITE 1040
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8839
Practice Address - Country:US
Practice Address - Phone:601-955-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS120972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118583Medicaid
MS12097OtherSTATE LICENSE
MS$$$$$$$$$BOtherBLUE CROSS AND BLUE SHIELD OF MISSISSIPPI (OUTPATIENT, PRIVATE OFFICE ONLY)
MS00118583Medicaid
MS5121260089Medicare PIN