Basic Information
| Provider Information | |||||||||
| NPI: | 1265627418 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EDWIN T. CASTANEDA, MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10324 OLD OCEAN CITY BLVD | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218111132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106290041 | ||||||||
| FaxNumber: | 4106419515 | ||||||||
| Practice Location | |||||||||
| Address1: | 10324 OLD OCEAN CITY BLVD | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218111132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106290041 | ||||||||
| FaxNumber: | 4106419515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2007 | ||||||||
| LastUpdateDate: | 09/12/2007 | ||||||||
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| AuthorizedOfficialLastName: | CASTANEDA | ||||||||
| AuthorizedOfficialFirstName: | EDWIN | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4106290041 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.