Provider Demographics
NPI: | 1952307613 |
---|---|
Name: | LOCASTRO, ROSEMARY H (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ROSEMARY |
Middle Name: | H |
Last Name: | LOCASTRO |
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: | 3535 QUAKERBRIDGE RD |
Mailing Address - Street 2: | STE 300 |
Mailing Address - City: | MERCERVILLE |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08619-1200 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 609-890-0033 |
Mailing Address - Fax: | 609-689-6067 |
Practice Address - Street 1: | 8 QUAKERBRIDGE PLZ |
Practice Address - Street 2: | |
Practice Address - City: | TRENTON |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08619-1255 |
Practice Address - Country: | US |
Practice Address - Phone: | 609-890-0033 |
Practice Address - Fax: | 609-890-0440 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-06-27 |
Last Update Date: | 2007-09-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | MA04783100 | 2085N0904X, 2085R0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No | 2085N0904X | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | 0584801 | Medicaid | |
NJ | 0584801 | Medicaid | |
NJ | B16686 | Medicare UPIN |