Provider Demographics
NPI:1083692560
Name:CASTILLO, TIRSO A (MD)
Entity Type:Individual
Prefix:
First Name:TIRSO
Middle Name:A
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1528
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-1528
Mailing Address - Country:US
Mailing Address - Phone:478-272-1366
Mailing Address - Fax:478-275-2322
Practice Address - Street 1:111 FAIRVIEW PARK DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2501
Practice Address - Country:US
Practice Address - Phone:478-272-1366
Practice Address - Fax:478-275-2322
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048883207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000872066AMedicaid
GA52420599-002OtherBCBS
GA681242OtherFIRST HEALTH
GA4653853OtherAETNA
GA1007287OtherUNITED HEALTHCARE
GA10BBCGXMedicare PIN
GAF32412Medicare UPIN
GA52420599-002OtherBCBS