Provider Demographics
NPI:1073610754
Name:CASEY, TERENCE THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:THOMAS
Last Name:CASEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3780
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803-3780
Mailing Address - Country:US
Mailing Address - Phone:318-841-9526
Mailing Address - Fax:318-841-9551
Practice Address - Street 1:1401 FOUCHER ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115
Practice Address - Country:US
Practice Address - Phone:504-897-8418
Practice Address - Fax:504-897-8762
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17902207ZP0102X
KY33861207ZP0102X
LA016061207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902737Medicaid
AL009963710Medicaid
GA10057953OtherAMERIGROUP MEDICAID GA
TN3040731Medicaid
GA335761OtherWELLCARE MEDICAID GA
GA644219559AMedicaid
TN3090762OtherBLUE CROSS
LA1901211Medicaid
TN000000009032OtherTLC TENNCARE
TN100031448OtherPHP TENNCARE
TN119402OtherUNISON TENNCARE
KY64720642Medicaid
AL009963710Medicaid
TN100031448OtherPHP TENNCARE
TN3090762OtherBLUE CROSS
TN3040731Medicaid