Provider Demographics
NPI:1316123797
Name:ANDERSON, CASTIN JOHANNA (MD)
Entity type:Individual
Prefix:
First Name:CASTIN
Middle Name:JOHANNA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KERSTIN
Other - Middle Name:
Other - Last Name:LEBERL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:54 BURGSTALL
Mailing Address - Street 2:
Mailing Address - City:MUTTERS
Mailing Address - State:TIROL
Mailing Address - Zip Code:6162
Mailing Address - Country:AT
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:54 BURGSTALL
Practice Address - Street 2:
Practice Address - City:MUTTERS
Practice Address - State:TIROL
Practice Address - Zip Code:6162
Practice Address - Country:AT
Practice Address - Phone:941-925-3907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-37626207LP3000X
IA37626207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA71362OtherWELLMARK BCBS
IAI0923001Medicare PIN
IAP00451750Medicare UPIN