Healthcare Provider Details

I. General information

NPI: 1114999851
Provider Name (Legal Business Name): BRIAN JOHN DECASTRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 JOSEPH SIEWICK DR STE 305
FAIRFAX VA
22033-1714
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 571-472-0912
  • Fax: 571-665-6770
Mailing address:
  • Phone: 571-423-5699
  • Fax: 571-423-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101254296
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: