Basic Information
| Provider Information | |||||||||
| NPI: | 1437380862 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTILLO | ||||||||
| FirstName: | TONY | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 532 W PITTSBURGH ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156012239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248324000 | ||||||||
| FaxNumber: | 7248308613 | ||||||||
| Practice Location | |||||||||
| Address1: | 532 W PITTSBURGH ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156012239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248324000 | ||||||||
| FaxNumber: | 7248308613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2009 | ||||||||
| LastUpdateDate: | 05/18/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD456838 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | MD456838 | PA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1030980940001 | 05 | PA | MEDICAID |