Provider Demographics
NPI:1427011600
Name:CASTILLO, MANUEL M (MD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:M
Last Name:CASTILLO
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 1:3101 BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-2429
Mailing Address - Country:US
Mailing Address - Phone:412-881-4220
Mailing Address - Fax:412-881-9270
Practice Address - Street 1:3101 BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-2429
Practice Address - Country:US
Practice Address - Phone:412-881-4220
Practice Address - Fax:412-881-9270
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-034512L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005983440003Medicaid
PA0005983440003Medicaid
PA066044G8LMedicare ID - Type Unspecified