Basic Information
Provider Information
NPI: 1003298126
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CASTELLANOS
FirstName: DANIEL
MiddleName: ALEXANDER
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 300 LONGWOOD AVE
Address2:  
City: BOSTON
State: MA
PostalCode: 021155724
CountryCode: US
TelephoneNumber: 6173556000
FaxNumber:  
Practice Location
Address1: 300 LONGWOOD AVE
Address2:  
City: BOSTON
State: MA
PostalCode: 021155724
CountryCode: US
TelephoneNumber: 6173556000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/25/2015
LastUpdateDate: 08/02/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/02/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0202X283956MAY Allopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
2080P0202XETL5309MAN Allopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
2080P0202XQ8849TXN Allopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology

No ID Information.


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