Provider Demographics
NPI:1053315440
Name:CASTILLENTI, THOMAS A (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:CASTILLENTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13345 THOROUGHBRED DR
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-6215
Mailing Address - Country:US
Mailing Address - Phone:813-309-2829
Mailing Address - Fax:
Practice Address - Street 1:13345 THOROUGHBRED DR
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-6215
Practice Address - Country:US
Practice Address - Phone:813-309-2829
Practice Address - Fax:813-355-5065
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS85142086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262814700Medicaid
FLP00669478OtherRR MEDICARE
FLE29253Medicare UPIN
FL06281WMedicare PIN