Provider Demographics
NPI:1861631301
Name:RICARDO C BIERRENBACH DECASTRO,MD,PA
Entity Type:Organization
Organization Name:RICARDO C BIERRENBACH DECASTRO,MD,PA
Other - Org Name:RICARDO C BIERRENBACH,MD,PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:R
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-692-7300
Mailing Address - Street 1:PO BOX 2272
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28793-2272
Mailing Address - Country:US
Mailing Address - Phone:828-692-7300
Mailing Address - Fax:828-692-7710
Practice Address - Street 1:110 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-4543
Practice Address - Country:US
Practice Address - Phone:828-692-7300
Practice Address - Fax:828-692-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002008662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913428Medicaid
2008334DOtherMEDICARE GROUP #
2008334DOtherMEDICARE GROUP #