Provider Demographics
NPI:1760467971
Name:CASPER, RODD LEIGHTON (PA C)
Entity type:Individual
Prefix:
First Name:RODD
Middle Name:LEIGHTON
Last Name:CASPER
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:2755 S HIGHWAY 14 STE 1200L
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4902
Practice Address - Country:US
Practice Address - Phone:864-849-9150
Practice Address - Fax:864-849-9394
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA 00254363A00000X
MA1281363A00000X
SC5181363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI24192OtherCONTROLLED SUBSTANCE
MAMC0437550JOtherCONTROLLED SUBSTANCE
05 0501339OtherHEALTHCARE VALUE MANAG
12266RIHOtherHARVARD PILGRIM
720118301OtherCIGNA
1156OtherNEIGHBORHOOD HEALTH PLAN
408400OtherBLUE CHIP
05 0501339OtherSIERRA MILITARY
MA1281OtherLICENCE
RIPA00254OtherLICENCE
RI23281 0OtherBLUE CROSS
SC6807PAMedicaid
9023281OtherEDS OF RI INDIV
NS34351OtherEDS OF RI GROUP
05 0501339OtherTAX ID
SCSCS5777628OtherMEDICARE PIN