Healthcare Provider Details

I. General information

NPI: 1417035338
Provider Name (Legal Business Name): SERGIO R CASILLAS-ROMERO MD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CASE ST SUITE 313
NORWICH CT
06360-2222
US

IV. Provider business mailing address

112 LAFAYETTE STREET
NORWICH CT
06360
US

V. Phone/Fax

Practice location:
  • Phone: 860-204-9126
  • Fax: 860-204-9146
Mailing address:
  • Phone: 860-425-8735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number41831
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number41831
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: