Healthcare Provider Details

I. General information

NPI: 1639198385
Provider Name (Legal Business Name): ADALBERTO ROMAN CASTELLANOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 NICHOLASVILLE RD STE 202
LEXINGTON KY
40503-1412
US

IV. Provider business mailing address

1401 HARRODSBURG RD STE B355
LEXINGTON KY
40504-3747
US

V. Phone/Fax

Practice location:
  • Phone: 859-260-5064
  • Fax:
Mailing address:
  • Phone: 859-276-5262
  • Fax: 859-277-6509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number36158
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: