Provider Demographics
NPI:1942301130
Name:CASTRO, MARY JANE SUNGA (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE SUNGA
Last Name:CASTRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JANE
Other - Last Name:CASTRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2929 CALDER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1845
Mailing Address - Country:US
Mailing Address - Phone:409-833-9797
Mailing Address - Fax:409-654-6886
Practice Address - Street 1:2400 HIGHWAY 365
Practice Address - Street 2:SUITE 201
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6249
Practice Address - Country:US
Practice Address - Phone:409-833-9797
Practice Address - Fax:409-654-6810
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212580903Medicaid
TX260160YLESMedicare Oscar/Certification
HIH30864Medicare UPIN
TX260160YLESMedicare PIN