Healthcare Provider Details

I. General information

NPI: 1275743221
Provider Name (Legal Business Name): EDUARDO CASTILLO DEL CASTILLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 MINSTREL WAY STE 100
COLUMBIA MD
21045-5274
US

IV. Provider business mailing address

7120 MINSTREL WAY STE 100
COLUMBIA MD
21045-5274
US

V. Phone/Fax

Practice location:
  • Phone: 844-814-5742
  • Fax: 866-529-2897
Mailing address:
  • Phone: 844-814-5742
  • Fax: 866-529-2897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25113
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0085459
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: