Provider Demographics
NPI:1538306337
Name:CASTELLINI, LAUREN (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:CASTELLINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:IMWALLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 636324
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6324
Mailing Address - Country:US
Mailing Address - Phone:859-301-2238
Mailing Address - Fax:859-301-4946
Practice Address - Street 1:1 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:859-301-2238
Practice Address - Fax:859-301-4946
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072449A2085R0001X
OH35.1211572085R0001X
KY463482085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100264040Medicaid
KYP01303881OtherMEDICARE RAILROAD
OH0088707Medicaid
OHP01332414OtherMEDICARE RAILROAD
IN201155740Medicaid
KYK098510Medicare PIN
IN176760005Medicare PIN
OHH220730Medicare PIN