Provider Demographics
NPI:1699559625
Name:T CASTELLANO MD LLC
Entity type:Organization
Organization Name:T CASTELLANO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-775-7284
Mailing Address - Street 1:762 W EISENHOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-3157
Mailing Address - Country:US
Mailing Address - Phone:303-588-9425
Mailing Address - Fax:
Practice Address - Street 1:762 W EISENHOWER BLVD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3157
Practice Address - Country:US
Practice Address - Phone:303-558-9425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty