Healthcare Provider Details

I. General information

NPI: 1245223478
Provider Name (Legal Business Name): JOSE I CASTILLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 E BROAD ST
HAZLETON PA
18201-5667
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-2902
  • Fax: 570-459-6090
Mailing address:
  • Phone: 570-271-6144
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD069930L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: