Provider Demographics
NPI:1730290180
Name:CASALE, PETER J (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:CASALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PLAZA CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8258
Mailing Address - Country:US
Mailing Address - Phone:570-421-7292
Mailing Address - Fax:570-421-3851
Practice Address - Street 1:100 PLAZA CT
Practice Address - Street 2:SUITE A
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8258
Practice Address - Country:US
Practice Address - Phone:570-421-7292
Practice Address - Fax:570-421-3851
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD 040327-L207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11911770006Medicaid
PACA46690Medicare ID - Type Unspecified
PA11911770006Medicaid