Healthcare Provider Details

I. General information

NPI: 1124262811
Provider Name (Legal Business Name): JASON ALFRED CASTELLANOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 COTTMAN AVE
PHILADELPHIA PA
19111-2497
US

IV. Provider business mailing address

2146 BELCOURT AVE VMG BUSINESS OFFICE
NASHVILLE TN
37212-3504
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-3095
  • Fax: 215-728-2773
Mailing address:
  • Phone: 615-322-4916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD471916
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: