Provider Demographics
NPI:1518616895
Name:CASTANEDA, EVERARDO ESAU (MD)
Entity Type:Individual
Prefix:
First Name:EVERARDO
Middle Name:ESAU
Last Name:CASTANEDA
Suffix:
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 1:64 MEDICAL CENTER DR STE 1310
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3409
Mailing Address - Country:US
Mailing Address - Phone:304-293-2342
Mailing Address - Fax:304-293-7725
Practice Address - Street 1:64 MEDICAL CENTER DR STE 1310
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3409
Practice Address - Country:US
Practice Address - Phone:304-293-2342
Practice Address - Fax:304-293-7725
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program