Healthcare Provider Details

I. General information

NPI: 1649353897
Provider Name (Legal Business Name): LAURA MARTINA DECASTRO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 CENTRE AVE 5TH FL. ROOM 562
PITTSBURGH PA
15232-1309
US

IV. Provider business mailing address

5150 CENTRE AVE 5TH FL. ROOM 562
PITTSBURGH PA
15232-1309
US

V. Phone/Fax

Practice location:
  • Phone: 412-623-7026
  • Fax: 412-648-6579
Mailing address:
  • Phone: 412-623-7026
  • Fax: 412-648-6579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number98-01233
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number450000
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: