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1083706568 NPI number — EMMA EVERLYN TUNAC CASTILLO BERCASIO MD

NPI Number: 1083706568
Health Care Provider/Practitioner: EMMA EVERLYN TUNAC CASTILLO BERCASIO MD

Information about “1083706568” NPI (EMMA EVERLYN TUNAC CASTILLO BERCASIO MD) exists in 1083706568 in HTML format HTML  |  1083706568 in plain Text format TXT  |  1083706568 in PDF (Portable Document Format) PDF  |  1083706568 in an XML format XML  formats.

NPI Number : 1083706568 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083706568",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CASTILLO BERCASIO",
    "FirstName": "EMMA",
    "MiddleName": "EVERLYN TUNAC",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CASTILLLO",
    "OtherFirstName": "EMMA",
    "OtherMiddleName": "EVERLYN TUNAC",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "400 SENTARA CIR STE 201B",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WILLIAMSBURG",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "23188-5716",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "757-345-4655",
    "MailingAddressFaxNumber": "757-390-4892",
    "FirstLinePracticeLocationAddress": "400 SENTARA CIR STE 201B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WILLIAMSBURG",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23188-5716",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "757-345-4655",
    "PracticeLocationAddressFaxNumber": "757-390-4892",
    "EnumerationDate": "09/29/2006",
    "LastUpdateDate": "06/02/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207RI0200X",
          "TaxonomyName": "Infectious Disease Physician",
          "LicenseNumber": "200100655",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207RI0200X",
          "TaxonomyName": "Infectious Disease Physician",
          "LicenseNumber": "0101266473",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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