Provider Demographics
NPI:1063480655
Name:CASTERELLA, PETER J (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:CASTERELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 17TH AVE
Mailing Address - Street 2:680
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122
Mailing Address - Country:US
Mailing Address - Phone:206-320-5391
Mailing Address - Fax:206-215-4550
Practice Address - Street 1:1600 E JEFFERSON ST
Practice Address - Street 2:610
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5698
Practice Address - Country:US
Practice Address - Phone:206-320-5391
Practice Address - Fax:206-215-4550
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4963061-1205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806129500Medicaid
NV002082167Medicaid
060065011OtherRR MEDICARE
UTD4141Medicaid
WY116655700Medicaid
WY116655700Medicaid
ID806129500Medicaid
WYW10339Medicare PIN