Provider Demographics
NPI:1285648865
Name:CASTRIOTTA, RALPH JOHN JR (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:JOHN
Last Name:CASTRIOTTA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4210
Practice Address - Country:US
Practice Address - Phone:864-455-8431
Practice Address - Fax:864-455-8981
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC135432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC135437Medicaid
SC135437Medicaid
SC135437Medicaid