Provider Demographics
NPI:1649506494
Name:CASTELLANOS NOUEL, MARIELY (MD)
Entity type:Individual
Prefix:
First Name:MARIELY
Middle Name:
Last Name:CASTELLANOS NOUEL
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 1:915 TATE BLVD SE
Mailing Address - Street 2:SUITE 186
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4042
Mailing Address - Country:US
Mailing Address - Phone:828-449-8458
Mailing Address - Fax:828-323-8348
Practice Address - Street 1:915 TATE BLVD SE
Practice Address - Street 2:SUITE 186
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4042
Practice Address - Country:US
Practice Address - Phone:828-449-8458
Practice Address - Fax:828-323-8348
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29829207R00000X
NC2012-01995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine