MEDICARE: CASTORIA SEYMORE JR. MD

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
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	C31929	CA

General Provider Information

NPI Number	:	1831282359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASTORIA SEYMORE JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 451275
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-8513
Country	:	US
Telephone Number	:	310-792-3914
Fax Number	:	855-898-4055

Provider Business Practice Location Address
First Line	:	1200 ROSECRANS AVE 208
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-2470
Country	:	US
Telephone Number	:	310-416-9700
Fax Number	:	310-216-0226

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	11/04/2015

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