Provider Demographics
NPI:1083706568
Name:CASTILLO, EMMA EVERLYN T (MD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:EVERLYN T
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SENTARA CIR STE 201B
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5716
Mailing Address - Country:US
Mailing Address - Phone:757-345-4655
Mailing Address - Fax:757-390-4892
Practice Address - Street 1:400 SENTARA CIR STE 201B
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5716
Practice Address - Country:US
Practice Address - Phone:757-345-4655
Practice Address - Fax:757-390-4892
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100655207RI0200X
VA0101266473207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00671694OtherMEDICARE RAILROAD
NC4213840OtherCIGNA
NC5900019Medicaid
NC129XGOtherBCBS
NCH54437Medicare UPIN
NC2291907BMedicare PIN
NC5900019Medicaid