Provider Demographics
NPI:1255334371
Name:KASTAN, MICHAEL BARRY (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BARRY
Last Name:KASTAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 63362
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3362
Mailing Address - Country:US
Mailing Address - Phone:919-620-4541
Mailing Address - Fax:919-620-4921
Practice Address - Street 1:2100 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3941
Practice Address - Country:US
Practice Address - Phone:919-684-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN305572080P0207X
NC2011-018722080P0207X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010056187Medicaid
WY1135066 00Medicaid
LA1555533Medicaid
ME422400000Medicaid
AL009913800Medicaid
IN200190170AMedicaid
MS00119795Medicaid
IA0527887Medicaid
OH2064582Medicaid
KY64929516Medicaid
TX060489401Medicaid
OK100034850AMedicaid
TN3827798Medicaid
KY64929516Medicaid
AL009913800Medicaid