Healthcare Provider Details

I. General information

NPI: 1578844775
Provider Name (Legal Business Name): GEORGINA POLANCO CASTILLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8340 BANDFORD WAY STE 1
RALEIGH NC
27615-2755
US

IV. Provider business mailing address

8340 BANDFORD WAY STE 1
RALEIGH NC
27615-2755
US

V. Phone/Fax

Practice location:
  • Phone: 919-845-3332
  • Fax:
Mailing address:
  • Phone: 919-845-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD2015-0855
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2020-0766
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301099326
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: