Provider Demographics
NPI:1730155698
Name:CASEY, BRENNA W (MD)
Entity type:Individual
Prefix:DR
First Name:BRENNA
Middle Name:W
Last Name:CASEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BRENNA
Other - Middle Name:C
Other - Last Name:BOUNDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:GASTROENTEROLOGY ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-724-1685
Practice Address - Fax:617-724-5997
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA161155207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ22586OtherBCBS MA
MA0107280Medicaid
MA161155OtherTUFTS HEALTH PLAN
MAA31205Medicare ID - Type Unspecified
MA161155OtherTUFTS HEALTH PLAN