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General NPI Number Information
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NPI Number | 1578844775
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Entity Type | Individual
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Provider Name | GEORGINA POLANCO CASTILLO MD
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Gender | Female
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Dates
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Enumeration Date | 08/31/2011
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 8340 BANDFORD WAY STE 1
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City | RALEIGH
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State | NC
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Zip | 27615-2755
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Country | US
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Telephone | 919-845-3332
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Fax |
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Provider Business Mailing Address
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Address Line | 8340 BANDFORD WAY STE 1
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City | RALEIGH
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State | NC
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Zip | 27615-2755
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Country | US
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Telephone | 919-845-3332
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MD2015-0855
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 2020-0766
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301099326
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License Number State | MI
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