Healthcare Provider Details

I. General information

NPI: 1275797730
Provider Name (Legal Business Name): MARICEL DEL CARMEN CASTANER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 COAL VALLEY RD SUITE 400
JEFFERSON HILLS PA
15025-3730
US

IV. Provider business mailing address

247 MOREWOOD AVE
PITTSBURGH PA
15213-1861
US

V. Phone/Fax

Practice location:
  • Phone: 412-267-6500
  • Fax: 412-267-6524
Mailing address:
  • Phone: 412-622-0290
  • Fax: 412-681-7605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD445468
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1027596250001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: