Provider Demographics
NPI:1992756076
Name:CASEY, LISA M (RD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:CASEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:MELILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 TER HEUN DRIVE
Mailing Address - Street 2:FALMOUTH HOSPITAL
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540
Mailing Address - Country:US
Mailing Address - Phone:508-299-8354
Mailing Address - Fax:508-299-8355
Practice Address - Street 1:100 TER HEUN DRIVE
Practice Address - Street 2:FALMOUTH HOSPITAL
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540
Practice Address - Country:US
Practice Address - Phone:508-299-8354
Practice Address - Fax:508-299-8355
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA462133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P44789Medicare UPIN
MT0026Medicare ID - Type Unspecified