Provider Demographics
NPI:1770004376
Name:CASTANO, LAUREL (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:CASTANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13320 BAKER MILLS RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-7365
Mailing Address - Country:US
Mailing Address - Phone:704-654-9074
Mailing Address - Fax:
Practice Address - Street 1:10370 PARK RD STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8509
Practice Address - Country:US
Practice Address - Phone:704-542-3003
Practice Address - Fax:704-542-3040
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07394207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology