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NPI Code Detail

MEDICARE: LAUREL CASTANO PA-C

MEDICARE:   LAUREL  CASTANO  PA-C
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
1207N00000XDermatology Physician0010-07394NC

General Provider Information

NPI Number : 1770004376
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREL CASTANO PA-C
Provider Business Mailing Address
First Line : 13320 BAKER MILLS RD
Second Line :
City : PINEVILLE
State : NC
Zip : 28134-7365
Country : US
Telephone Number : 704-654-9074
Fax Number :
Provider Business Practice Location Address
First Line : 10370 PARK RD STE 201
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-8509
Country : US
Telephone Number : 704-542-3003
Fax Number : 704-542-3040
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2017
Last Update Date : 07/05/2017

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Directions to “ LAUREL CASTANO PA-C” Practice Location

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