Basic Information
Provider Information | |||||||||
NPI: | 1306046719 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | RICHARD J. CASTIELLO, M.D., P.A. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5530 WISCONSIN AVE | ||||||||
Address2: | 1418 | ||||||||
City: | CHEVY CHASE | ||||||||
State: | MD | ||||||||
PostalCode: | 208154404 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3019861880 | ||||||||
FaxNumber: | 3017187372 | ||||||||
Practice Location | |||||||||
Address1: | 5530 WISCONSIN AVE | ||||||||
Address2: | 1418 | ||||||||
City: | CHEVY CHASE | ||||||||
State: | MD | ||||||||
PostalCode: | 208154404 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3019861880 | ||||||||
FaxNumber: | 3017187372 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/23/2007 | ||||||||
LastUpdateDate: | 11/06/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | PASSES | ||||||||
AuthorizedOfficialFirstName: | GAYE | ||||||||
AuthorizedOfficialMiddleName: | EILEEN | ||||||||
AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
AuthorizedOfficialTelephone: | 3019861880 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | D13753 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |   |
No ID Information.