Provider Demographics
NPI:1023296845
Name:DAVID P LOCASTRO, MD, PC
Entity type:Organization
Organization Name:DAVID P LOCASTRO, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:LOCASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-685-7943
Mailing Address - Street 1:764 W GENESEE STREET RD
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-9311
Mailing Address - Country:US
Mailing Address - Phone:315-685-7943
Mailing Address - Fax:315-685-2325
Practice Address - Street 1:764 W GENESEE STREET RD
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-9311
Practice Address - Country:US
Practice Address - Phone:315-685-7943
Practice Address - Fax:315-685-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205293208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56630BOtherMEDICARE ID
NY01735886Medicaid
NYF95637Medicare UPIN
BA1392Medicare PIN