Provider Demographics
NPI:1922062157
Name:O'DONNELL, CASEY (DO, MBA)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:DO, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02129-2056
Mailing Address - Country:US
Mailing Address - Phone:617-952-5299
Mailing Address - Fax:
Practice Address - Street 1:2 POND PARK RD STE 303
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4354
Practice Address - Country:US
Practice Address - Phone:781-624-2525
Practice Address - Fax:781-741-6297
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2024-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07680200208100000X
PAOS013626208100000X
RIDO006142081P2900X, 208VP0014X
FLOS114042081P2900X
MA234536208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019522600Medicaid
FL019522600Medicaid
FLFQ852X-TPAMedicare PIN
FLP01785149-RAILROADMedicare PIN