Healthcare Provider Details

I. General information

NPI: 1760778047
Provider Name (Legal Business Name): KEVIN CASTILLO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 VALLEYGATE DR STE 101
FAYETTEVILLE NC
28304-3746
US

IV. Provider business mailing address

1638 OWEN DR
FAYETTEVILLE NC
28304-3424
US

V. Phone/Fax

Practice location:
  • Phone: 910-223-7011
  • Fax: 910-323-3650
Mailing address:
  • Phone: 910-615-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number34.011963
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2026-03144
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: