Basic Information
| Provider Information | |||||||||
| NPI: | 1043336613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NICASTRO | ||||||||
| FirstName: | OSWALDO | ||||||||
| MiddleName: | APOLINAR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2002 FOULK RD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198103643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023340330 | ||||||||
| FaxNumber: | 3023340329 | ||||||||
| Practice Location | |||||||||
| Address1: | 2002 FOULK RD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198103643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023340330 | ||||||||
| FaxNumber: | 3023340329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 07/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | C1-0008737 | DE | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1043336613 | 05 | DE | MEDICAID |