Provider Demographics
NPI:1194780577
Name:CASPER, ELIZABETH A (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:CASPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5172 LEAVITT RD
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2384
Mailing Address - Country:US
Mailing Address - Phone:440-204-7439
Mailing Address - Fax:440-988-5652
Practice Address - Street 1:5172 LEAVITT RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2384
Practice Address - Country:US
Practice Address - Phone:440-204-7439
Practice Address - Fax:440-988-5652
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002245RX363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN667640SMedicare PIN
INW83348Medicare UPIN