Provider Demographics
NPI: | 1174508576 |
---|---|
Name: | CONCEPCION-CASTRO, ANA MARIA (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ANA |
Middle Name: | MARIA |
Last Name: | CONCEPCION-CASTRO |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 11702 MERCY BLVD |
Mailing Address - Street 2: | STE. 2E |
Mailing Address - City: | SAVANNAH |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 31419-1750 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 912-925-8883 |
Mailing Address - Fax: | 912-925-8689 |
Practice Address - Street 1: | 11702 MERCY BLVD |
Practice Address - Street 2: | STE. 2E |
Practice Address - City: | SAVANNAH |
Practice Address - State: | GA |
Practice Address - Zip Code: | 31419-1750 |
Practice Address - Country: | US |
Practice Address - Phone: | 912-925-8883 |
Practice Address - Fax: | 912-925-8689 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2005-12-08 |
Last Update Date: | 2010-10-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | 047070 | 207RI0200X, 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
GA | G95048 | Other | UPIN |
GA | 44ZCBJH | Other | MEDICARE PIN |
GA | 000821609D | Medicaid |