Provider Demographics
NPI:1912961525
Name:CASERTA, LARRY ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ALLEN
Last Name:CASERTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LARRY
Other - Middle Name:ALLEN
Other - Last Name:CASERTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:104 MEADOW POINTE
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-9209
Mailing Address - Country:US
Mailing Address - Phone:304-525-5405
Mailing Address - Fax:304-525-3400
Practice Address - Street 1:104 MEADOW POINTE
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-9209
Practice Address - Country:US
Practice Address - Phone:304-525-5405
Practice Address - Fax:304-525-3400
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09978207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000028532OtherBCBS
WV0091392000Medicaid
WV7893OtherACORDIA
WV7893OtherACORDIA
A71997Medicare UPIN