Basic Information
Provider Information
NPI: 1124354014
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CASATI
FirstName: ALDEN
MiddleName: KENNEDY
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2920 HIGHWOODS BLVD
Address2:  
City: RALEIGH
State: NC
PostalCode: 276040010
CountryCode: US
TelephoneNumber: 8774984490
FaxNumber:  
Practice Location
Address1: 3024 NEW BERN AVE
Address2:  
City: RALEIGH
State: NC
PostalCode: 276101247
CountryCode: US
TelephoneNumber: 9193507251
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/27/2009
LastUpdateDate: 02/17/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/17/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X0010-01952NCY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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