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General NPI Number Information
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NPI Number | 1063480655
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Entity Type | Individual
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Provider Name | PETER J CASTERELLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 1600 E JEFFERSON ST 610
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City | SEATTLE
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State | WA
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Zip | 98122-5698
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Country | US
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Telephone | 206-320-5391
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Fax | 206-215-4550
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Provider Business Mailing Address
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Address Line | 550 17TH AVE 680
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City | SEATTLE
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State | WA
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Zip | 98122
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Country | US
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Telephone | 206-320-5391
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Fax | 206-215-4550
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 4963061-1205
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License Number State | UT
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