Provider Demographics
NPI:1104353051
Name:CASTILLO RODRIGUEZ, MARCO ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:ANTONIO
Last Name:CASTILLO RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CORPORATE DR FL 9
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6238
Mailing Address - Country:US
Mailing Address - Phone:203-929-7353
Mailing Address - Fax:866-623-8110
Practice Address - Street 1:80 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3300
Practice Address - Country:US
Practice Address - Phone:860-545-5000
Practice Address - Fax:860-545-5066
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT75453207L00000X
FLTRN23953207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT75453OtherCONNECTICUT LICENSE
MST4881OtherMISSISSIPPI STATE BOARD LICENSURE
CT75453Medicaid