1619978285 NPI number — Personalized Hematology Oncology of Wake Forest, PLLC DR. FRANCISCO A CASTILLOS MD

Table of content: DR. FRANCISCO A CASTILLOS MD (NPI 1619978285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619978285 NPI number — Personalized Hematology Oncology of Wake Forest, PLLC DR. FRANCISCO A CASTILLOS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Personalized Hematology Oncology of Wake Forest, PLLC
Provider Last Name:
CASTILLOS
Provider First Name:
FRANCISCO
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619978285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11635 NORTHPARK DR
Provider Second Line Business Mailing Address:
SUITE#250
Provider Business Mailing Address City Name:
WAKE FOREST
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27587-6526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-825-4637
Provider Business Mailing Address Fax Number:
919-562-0444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11635 NORTHPARK DR
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
WAKE FOREST
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27587-6526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-825-4637
Provider Business Practice Location Address Fax Number:
919-562-0444
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
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Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  200400833 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2019007 . This is a "UNITED HEALTH CARE ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89137UC , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: D6867 . This is a "MEDCOST ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 137UC . This is a "BLUE CROSS BLUE SHIELD ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1820724 . This is a "FIRST HEALTH ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7033081 . This is a "AETNA ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8200569 . This is a "CIGNA ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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