Provider Demographics
NPI:1831535418
Name:CASTELLANO, TARA (MD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:CASTELLANO
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 1:800 NE 10TH ST # 5050
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5418
Mailing Address - Country:US
Mailing Address - Phone:405-271-7770
Mailing Address - Fax:
Practice Address - Street 1:800 NE 10TH ST # 5050
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5418
Practice Address - Country:US
Practice Address - Phone:405-271-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32691207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology