Provider Demographics
NPI:1942386966
Name:MAC, FEMINIA CASTRO (MD)
Entity Type:Individual
Prefix:DR
First Name:FEMINIA
Middle Name:CASTRO
Last Name:MAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-1436
Mailing Address - Country:US
Mailing Address - Phone:973-589-3566
Mailing Address - Fax:973-589-1707
Practice Address - Street 1:18 FERRY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1436
Practice Address - Country:US
Practice Address - Phone:973-589-3566
Practice Address - Fax:973-589-1707
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ283302080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28330OtherMEDICAL LICENSE
NJ3921905Medicaid
NJ222153220OtherTAX ID NUMBER