Provider Demographics
NPI:1265627418
Name:EDWIN T. CASTANEDA, MD PA
Entity type:Organization
Organization Name:EDWIN T. CASTANEDA, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:CASTANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-629-0041
Mailing Address - Street 1:10324 OLD OCEAN CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1132
Mailing Address - Country:US
Mailing Address - Phone:410-629-0041
Mailing Address - Fax:410-641-9515
Practice Address - Street 1:10324 OLD OCEAN CITY BLVD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1132
Practice Address - Country:US
Practice Address - Phone:410-629-0041
Practice Address - Fax:410-641-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty