Provider Demographics
NPI:1043290422
Name:MCCASKILL, SAMUEL G JR (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:G
Last Name:MCCASKILL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:511 RUIN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-5919
Mailing Address - Country:US
Mailing Address - Phone:252-492-8576
Mailing Address - Fax:252-492-7464
Practice Address - Street 1:511 RUIN CREEK RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-5919
Practice Address - Country:US
Practice Address - Phone:252-492-8576
Practice Address - Fax:252-492-7464
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC27945207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5580075OtherAETNA
NC07-55208OtherUNITEDHEALTH CARE
NC55399OtherBLUE CROSS OF NC
NC151108OtherWELLPATH
NC27751OtherMEDCOST
NC89-55399Medicaid
VA072995OtherBLUE CROSS OF VA
NC5580075OtherAETNA
NC208644Medicare ID - Type Unspecified