Basic Information
| Provider Information | |||||||||
| NPI: | 1639233794 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTELLO | ||||||||
| FirstName: | FRED | ||||||||
| MiddleName: | MARK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 78 MEDICAL CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | FISHERSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409324000 | ||||||||
| FaxNumber: | 5409324616 | ||||||||
| Practice Location | |||||||||
| Address1: | 78 MEDICAL CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | FISHERSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409324000 | ||||||||
| FaxNumber: | 5409324616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | VA0101035279 | VA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.