Provider Demographics
NPI:1770734253
Name:CASTLE BIOSCIENCES, INC
Entity type:Organization
Organization Name:CASTLE BIOSCIENCES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAETZOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-796-9032
Mailing Address - Street 1:2014 SAN MIGUEL DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5913
Mailing Address - Country:US
Mailing Address - Phone:281-796-9032
Mailing Address - Fax:866-431-2924
Practice Address - Street 1:3737 N 7TH ST
Practice Address - Street 2:SUITE 160
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5017
Practice Address - Country:US
Practice Address - Phone:281-796-9032
Practice Address - Fax:866-431-2924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100731920Medicaid
KS30004741190001Medicaid