Provider Demographics
NPI:1285637678
Name:CASTREE, KATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:CASTREE
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 1:10 DAVOL SQ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4754
Mailing Address - Country:US
Mailing Address - Phone:401-421-4000
Mailing Address - Fax:401-272-1456
Practice Address - Street 1:300 CENTERVILLE RD
Practice Address - Street 2:THE SUMMIT EAST, SUITE 110
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-0200
Practice Address - Country:US
Practice Address - Phone:401-615-2299
Practice Address - Fax:401-615-7529
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD06235208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIKC04329Medicaid
002070201OtherMEDICARE
F13148Medicare UPIN