Basic Information
Provider Information
NPI: 1871744763
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANDRADE
FirstName: OLIVIA
MiddleName: MARIE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: CASTELINO
OtherFirstName: OLIVIA
OtherMiddleName: MARIE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: M.D.
OtherLastNameType: 1
Mailing Information
Address1: 301 PROSPECT AVE
Address2: HOSPITAL INTERNISTS
City: SYRACUSE
State: NY
PostalCode: 132031807
CountryCode: US
TelephoneNumber: 3154485704
FaxNumber: 3154236853
Practice Location
Address1: 301 PROSPECT AVE
Address2: HOSPITAL INTERNISTS
City: SYRACUSE
State: NY
PostalCode: 132031807
CountryCode: US
TelephoneNumber: 3154485704
FaxNumber: 3154236853
Other Information
ProviderEnumerationDate: 10/09/2008
LastUpdateDate: 12/18/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X250604NYN Allopathic & Osteopathic PhysiciansEmergency Medicine 
207Q00000X250604NYN Allopathic & Osteopathic PhysiciansFamily Medicine 
208M00000X250604NYY Allopathic & Osteopathic PhysiciansHospitalist 

ID Information
IDTypeStateIssuerDescription
0307678005NY MEDICAID


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