Provider Demographics
NPI:1619409562
Name:O'CONNOR, CASEY MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:MICHAEL
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1367 WASHINGTON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1048
Mailing Address - Country:US
Mailing Address - Phone:518-631-3286
Mailing Address - Fax:
Practice Address - Street 1:1367 WASHINGTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1048
Practice Address - Country:US
Practice Address - Phone:518-631-3286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2025-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311076-01207X00000X
FLME154344207X00000X
NC2023-02413207X00000X
SC89648207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery