Healthcare Provider Details

I. General information

NPI: 1689891129
Provider Name (Legal Business Name): JORGE CASTILLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE M221
BOSTON MA
02215
US

IV. Provider business mailing address

450 BROOKLINE AVE M221
BOSTON MA
02215
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-6285
  • Fax: 401-444-5088
Mailing address:
  • Phone: 617-632-6285
  • Fax: 401-444-5088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberLP00533
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number257257
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: