Basic Information
| Provider Information | |||||||||
| NPI: | 1801065990 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASTRO | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | GABRIELA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 590 MANNING DR | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275996119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849740210 | ||||||||
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| Practice Location | |||||||||
| Address1: | 224 S 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | SILER CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273442779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196631744 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2008 | ||||||||
| LastUpdateDate: | 11/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2018-01424 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7100060890 | 05 | KY | MEDICAID |