MEDICARE: DR. DARIO ROMAN CASTELLANOS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	099171	NY

General Provider Information

NPI Number	:	1700874336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARIO ROMAN CASTELLANOS M.D.

Provider Business Mailing Address
First Line	:	391 E 149TH ST
Second Line	:	SUITE #214
City	:	BRONX
State	:	NY
Zip	:	10455-3907
Country	:	US
Telephone Number	:	718-665-8300
Fax Number	:	718-665-8301

Provider Business Practice Location Address
First Line	:	391 E 149TH ST
Second Line	:	SUITE #214
City	:	BRONX
State	:	NY
Zip	:	10455-3907
Country	:	US
Telephone Number	:	718-665-8300
Fax Number	:	718-665-8301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	04/26/2010

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