Healthcare Provider Details

I. General information

NPI: 1104353051
Provider Name (Legal Business Name): MARCO ANTONIO CASTILLO RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST
HARTFORD CT
06106-3300
US

IV. Provider business mailing address

2 CORPORATE DR FL 9
SHELTON CT
06484-6238
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-5000
  • Fax: 860-545-5066
Mailing address:
  • Phone: 203-929-7353
  • Fax: 866-623-8110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number75453
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: