Provider Demographics
NPI:1124281530
Name:CASASANTA, MARC JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:JOSEPH
Last Name:CASASANTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 OSBORNE ST STE 111
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6019
Mailing Address - Country:US
Mailing Address - Phone:203-739-7131
Mailing Address - Fax:203-739-1554
Practice Address - Street 1:111 OSBORNE ST STE 111
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-739-7131
Practice Address - Fax:203-739-1554
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279342208C00000X
CT61554208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery