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NPI Code Detail

MEDICARE: CASTOR PEDIATRICS PC

MEDICARE: CASTOR PEDIATRICS PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician

General Provider Information

NPI Number : 1730118712
Entity Type Code : Organization
Provider Name (Legal Business Name) : CASTOR PEDIATRICS PC
Provider Business Mailing Address
First Line : 6608 CASTOR AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19149-2120
Country : US
Telephone Number : 215-342-7710
Fax Number : 215-722-8712
Provider Business Practice Location Address
First Line : 6608 CASTOR AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19149-2120
Country : US
Telephone Number : 215-342-7710
Fax Number : 215-722-8712
Authorized Official
Title or Position : PRESIDENT
Name : DR. MARK J STY
Credential :
Telephone Number : 215-342-7710
Provider Enumeration Date : 07/01/2006
Last Update Date : 08/22/2020

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Directions to “CASTOR PEDIATRICS PC ” Practice Location

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