Provider Demographics
NPI:1154350551
Name:CASTILLO, PATRICIA A (PA-C)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 S BROADWAY
Mailing Address - Street 2:JAMES J PETERS VAMC, WHITE PLAINS CBOC
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-3503
Mailing Address - Country:US
Mailing Address - Phone:718-584-9000
Mailing Address - Fax:914-421-1956
Practice Address - Street 1:23 S BROADWAY
Practice Address - Street 2:JAMES J PETERS VAMC, WHITE PLAINS CBOC
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-3503
Practice Address - Country:US
Practice Address - Phone:718-584-9000
Practice Address - Fax:914-421-1956
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0027181363AM0700X
MA1932363AM0700X
NC103890363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1578514Medicaid
NY1578514Medicaid
NYZ88891Medicare ID - Type Unspecified