Provider Demographics
NPI:1124135025
Name:CASTILLO-ALCASID, MARIE E (MD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:E
Last Name:CASTILLO-ALCASID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-1228
Mailing Address - Country:US
Mailing Address - Phone:315-598-4715
Mailing Address - Fax:315-598-4733
Practice Address - Street 1:522 S 4TH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-2946
Practice Address - Country:US
Practice Address - Phone:315-598-4740
Practice Address - Fax:315-598-4719
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237698207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH15321Medicare UPIN
NYCC0465Medicare UPIN