Provider Demographics
NPI:1912227661
Name:CASTELBUONO, ANDRE THEODORE (MD)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:THEODORE
Last Name:CASTELBUONO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3535 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1221
Mailing Address - Country:US
Mailing Address - Phone:937-384-6800
Mailing Address - Fax:937-384-6896
Practice Address - Street 1:3535 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1221
Practice Address - Country:US
Practice Address - Phone:937-384-6800
Practice Address - Fax:937-384-6896
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2014-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN50127207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ001134Medicaid
TNP01223790OtherRAILROAD MEDICARE
TN4353212OtherBCBS OF TN
TN4353212OtherBCBS OF TN