Basic Information
| Provider Information | |||||||||
| NPI: | 1144216078 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASEY | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | COGAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 SAM PERRY BLVD | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224014453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407411100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4103 LAFAYETTE BLVD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224084229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408915550 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2005 | ||||||||
| LastUpdateDate: | 09/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0102307027 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2015-01577 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 2015-01577 | NC | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.