Provider Demographics
NPI:1306046719
Name:RICHARD J. CASTIELLO, M.D., P.A.
Entity type:Organization
Organization Name:RICHARD J. CASTIELLO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAYE
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:PASSES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-986-1880
Mailing Address - Street 1:5530 WISCONSIN AVE
Mailing Address - Street 2:1418
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:301-986-1880
Mailing Address - Fax:301-718-7372
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:1418
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-986-1880
Practice Address - Fax:301-718-7372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD13753174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG00215Medicare UPIN