Provider Demographics
NPI:1568604510
Name:ANTONIO CASTANEDA, MD, PA
Entity Type:Organization
Organization Name:ANTONIO CASTANEDA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASTANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-698-9700
Mailing Address - Street 1:1325 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 777
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2158
Mailing Address - Country:US
Mailing Address - Phone:817-698-9700
Mailing Address - Fax:817-698-9703
Practice Address - Street 1:1325 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 777
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2158
Practice Address - Country:US
Practice Address - Phone:817-698-9700
Practice Address - Fax:817-698-9703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2318208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty