Provider Demographics
NPI:1366805145
Name:MABRY, CASEY H (MD)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:H
Last Name:MABRY
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 1:6740 ALEXANDER BELL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2248
Mailing Address - Country:US
Mailing Address - Phone:410-564-0000
Mailing Address - Fax:
Practice Address - Street 1:6740 ALEXANDER BELL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2248
Practice Address - Country:US
Practice Address - Phone:410-564-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD89460208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics