MEDICARE: DR. BRADLEY DAVID CASTELLANO D.P.M.

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
1	213E00000X	Podiatrist	POD000569	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	65107	OTHER	GA	MEDICARE ID TYPE UNSPECIFIED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922079151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY DAVID CASTELLANO D.P.M.

Provider Business Mailing Address
First Line	:	1515 RIVER PL
Second Line	:	SUITE 140
City	:	BRASELTON
State	:	GA
Zip	:	30517-5602
Country	:	US
Telephone Number	:	770-648-5040
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 RIVER PL
Second Line	:	SUITE 140
City	:	BRASELTON
State	:	GA
Zip	:	30517-5602
Country	:	US
Telephone Number	:	770-648-5040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	01/20/2015

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Directions to “ DR. BRADLEY DAVID CASTELLANO D.P.M.” Practice Location

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