Provider Demographics
NPI:1669634440
Name:BELCASTRO, MARISA PAULINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISA
Middle Name:PAULINE
Last Name:BELCASTRO
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Gender:F
Credentials:MD
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Mailing Address - Street 1:630 SOUTHPOINT DR
Mailing Address - Street 2:LEXINGTON CLINIC VETERANS PARK
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6350
Mailing Address - Country:US
Mailing Address - Phone:859-272-1928
Mailing Address - Fax:859-271-9601
Practice Address - Street 1:630 SOUTHPOINT DR
Practice Address - Street 2:LEXINGTON CLINIC VETERANS PARK
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-6350
Practice Address - Country:US
Practice Address - Phone:859-272-1928
Practice Address - Fax:859-271-9601
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2016-06-01
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Provider Licenses
StateLicense IDTaxonomies
KY43144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0169Medicare PIN