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:
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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
StateLicense IDTaxonomies
GA047070207RI0200X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG95048OtherUPIN
GA44ZCBJHOtherMEDICARE PIN
GA000821609DMedicaid