Provider Demographics
NPI:1992763460
Name:CASTELLANO, THOMAS J (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:CASTELLANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:490 NORTHAMPTON ST
Mailing Address - Street 2:GATEWAY SUITE 1
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4551
Mailing Address - Country:US
Mailing Address - Phone:570-288-8100
Mailing Address - Fax:570-288-7987
Practice Address - Street 1:490 NORTHAMPTON ST
Practice Address - Street 2:GATEWAY SUITE 1
Practice Address - City:EDWARDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704-4551
Practice Address - Country:US
Practice Address - Phone:570-288-8100
Practice Address - Fax:570-288-7987
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD024935E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B41410Medicare UPIN
414536Medicare ID - Type Unspecified