Healthcare Provider Details

I. General information

NPI: 1083706568
Provider Name (Legal Business Name): EMMA EVERLYN TUNAC CASTILLO BERCASIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMMA EVERLYN TUNAC CASTILLLO

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SENTARA CIR STE 201B
WILLIAMSBURG VA
23188-5716
US

IV. Provider business mailing address

400 SENTARA CIR STE 201B
WILLIAMSBURG VA
23188-5716
US

V. Phone/Fax

Practice location:
  • Phone: 757-345-4655
  • Fax: 757-390-4892
Mailing address:
  • Phone: 757-345-4655
  • Fax: 757-390-4892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number200100655
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101266473
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: