Provider Demographics
NPI:1659683191
Name:A J CASTROVINCI MD INC
Entity Type:Organization
Organization Name:A J CASTROVINCI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASTROVINCI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:440-951-2304
Mailing Address - Street 1:7915 MUNSON RD
Mailing Address - Street 2:
Mailing Address - City:MENTOR ON THE LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44060-3744
Mailing Address - Country:US
Mailing Address - Phone:440-951-2304
Mailing Address - Fax:440-951-2304
Practice Address - Street 1:7915 MUNSON RD
Practice Address - Street 2:
Practice Address - City:MENTOR ON THE LAKE
Practice Address - State:OH
Practice Address - Zip Code:44060-3744
Practice Address - Country:US
Practice Address - Phone:440-951-2304
Practice Address - Fax:440-951-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35031291207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9389691Medicare PIN
OHA71399Medicare UPIN