Provider Demographics
NPI:1598856189
Name:CASTON, FREDERICK E (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:E
Last Name:CASTON
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 1:7 ALICIA CT
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3380
Mailing Address - Country:US
Mailing Address - Phone:631-689-1370
Mailing Address - Fax:
Practice Address - Street 1:7 ALICIA CT
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3380
Practice Address - Country:US
Practice Address - Phone:631-689-1370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9X7631Medicare PIN
NYH10643Medicare UPIN