Provider Demographics
NPI:1932176443
Name:HERSKOVITS CASTILLO, ELIZABETH J (MD PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:J
Last Name:HERSKOVITS CASTILLO
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:J
Other - Last Name:HERSKOVITS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 602373
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2373
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1011
Practice Address - Country:US
Practice Address - Phone:207-363-4321
Practice Address - Fax:207-363-0120
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01812207RG0300X, 207R00000X, 208M00000X
MEMD22347207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1932176443Medicaid
NC5905564Medicaid