Healthcare Provider Details

I. General information

NPI: 1144272857
Provider Name (Legal Business Name): DAVID P LOCASTRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 W GENESEE STREET RD
SKANEATELES NY
13152-9311
US

IV. Provider business mailing address

764 W GENESEE STREET RD
SKANEATELES NY
13152-9311
US

V. Phone/Fax

Practice location:
  • Phone: 315-685-7943
  • Fax: 315-685-2325
Mailing address:
  • Phone: 315-685-7943
  • Fax: 315-685-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number205293
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: