Provider Demographics
NPI:1851658231
Name:FARIAS, KRISTIN CASTILLO (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:CASTILLO
Last Name:FARIAS
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 1:75 FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6106
Mailing Address - Country:US
Mailing Address - Phone:617-983-7025
Mailing Address - Fax:857-307-4141
Practice Address - Street 1:1285 BEACON ST STE 101
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5237
Practice Address - Country:US
Practice Address - Phone:617-983-7025
Practice Address - Fax:857-307-4141
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME133787207R00000X, 208000000X
MA261528208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023257900Medicaid