Provider Demographics
NPI:1851484638
Name:CASTLEBERRY, GLENDA E
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:E
Last Name:CASTLEBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 LAFAYETTE ST
Mailing Address - Street 2:# 14
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4830
Mailing Address - Country:US
Mailing Address - Phone:857-364-5435
Mailing Address - Fax:857-364-4537
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:857-364-5435
Practice Address - Fax:857-364-4537
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAV130207OtherP&O FITTER