1659370112 NPI number — ROBERT CASTINO PHD

Table of content: ROBERT CASTINO PHD (NPI 1659370112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659370112 NPI number — ROBERT CASTINO PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTINO
Provider First Name:
ROBERT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1659370112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8500 EXECUTIVE PARK AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031-2225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-698-5220
Provider Business Mailing Address Fax Number:
703-573-2351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8500 EXECUTIVE PARK AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-2225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-698-5220
Provider Business Practice Location Address Fax Number:
703-573-2351
Provider Enumeration Date:
07/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  0810001924 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0023 . This is a "CAREFIRST DC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 513434 . This is a "NCPPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 202924 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 445086 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4299797 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 185163-000 . This is a "MAGELLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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