Provider Demographics
NPI:1982698122
Name:CASTANARES, ANTONIETTA MANCAO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIETTA
Middle Name:MANCAO
Last Name:CASTANARES
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 1:3235 ACADEMY AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-3200
Mailing Address - Country:US
Mailing Address - Phone:757-484-9400
Mailing Address - Fax:757-484-8809
Practice Address - Street 1:3235 ACADEMY AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-3200
Practice Address - Country:US
Practice Address - Phone:757-484-9400
Practice Address - Fax:757-484-8809
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010156999207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G15616Medicare UPIN
VA590000154Medicare ID - Type Unspecified