Provider Demographics
NPI:1588631683
Name:CASTELLANO-HOWARD, LISA M (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:CASTELLANO-HOWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:L
Other - Middle Name:M
Other - Last Name:CASTELLANO-HOWARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:306 S MACDILL AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3142
Mailing Address - Country:US
Mailing Address - Phone:813-879-6207
Mailing Address - Fax:813-875-9256
Practice Address - Street 1:306 S MACDILL AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3142
Practice Address - Country:US
Practice Address - Phone:813-879-6207
Practice Address - Fax:813-875-9256
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55709207N00000X
FLME0073940174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42555Medicare UPIN
FLG60984Medicare UPIN