Basic Information
| Provider Information | |||||||||
| NPI: | 1124262811 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASTELLANOS | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | ALFRED | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2146 BELCOURT AVE | ||||||||
| Address2: | VMG BUSINESS OFFICE | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372123504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153224916 | ||||||||
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| Practice Location | |||||||||
| Address1: | 333 COTTMAN AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191112497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157283095 | ||||||||
| FaxNumber: | 2157282773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2009 | ||||||||
| LastUpdateDate: | 08/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208600000X | MD471916 | PA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.