Provider Demographics
NPI:1588760201
Name:CASTLES, LISA M (PA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:CASTLES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:325 MERCY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-2331
Mailing Address - Country:US
Mailing Address - Phone:843-394-5471
Mailing Address - Fax:843-394-5459
Practice Address - Street 1:325 MERCY ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-2331
Practice Address - Country:US
Practice Address - Phone:843-394-5471
Practice Address - Fax:843-394-5459
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC432363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8305Medicare PIN
SCP13583Medicare UPIN