Provider Demographics
NPI:1649353897
Name:DECASTRO, LAURA MARTINA (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MARTINA
Last Name:DECASTRO
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 1:5150 CENTRE AVE
Mailing Address - Street 2:5TH FL. ROOM 562
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1309
Mailing Address - Country:US
Mailing Address - Phone:412-623-7026
Mailing Address - Fax:412-648-6579
Practice Address - Street 1:5150 CENTRE AVE
Practice Address - Street 2:5TH FL. ROOM 562
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1309
Practice Address - Country:US
Practice Address - Phone:412-623-7026
Practice Address - Fax:412-648-6579
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98-01233207RH0000X
PA450000207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7911125Medicare ID - Type Unspecified
G76507Medicare ID - Type Unspecified
NC2259868Medicare ID - Type Unspecified
NCG76507Medicare UPIN