Provider Demographics
NPI:1922397132
Name:DECASTRO, MARIE DINAH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:DINAH
Last Name:DECASTRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16800 NW 2ND AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5501
Mailing Address - Country:US
Mailing Address - Phone:877-868-4827
Mailing Address - Fax:
Practice Address - Street 1:16800 NW 2ND AVE STE 400
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169
Practice Address - Country:US
Practice Address - Phone:877-868-4827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119616207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine