Provider Demographics
NPI:1568789329
Name:MARIA C CASTELLANO, MD, LLC
Entity Type:Organization
Organization Name:MARIA C CASTELLANO, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CARMELA
Authorized Official - Last Name:CASTELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-490-0149
Mailing Address - Street 1:2418 N OAK ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2576
Mailing Address - Country:US
Mailing Address - Phone:912-490-0149
Mailing Address - Fax:
Practice Address - Street 1:2418 N OAK ST
Practice Address - Street 2:SUITE J
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2576
Practice Address - Country:US
Practice Address - Phone:912-490-0149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045419207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty