Provider Demographics
NPI:1083792352
Name:CASTRO, JOSE MARCIANO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE MARCIANO
Middle Name:
Last Name:CASTRO
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 1137
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-5137
Mailing Address - Country:US
Mailing Address - Phone:302-999-8169
Mailing Address - Fax:302-999-8190
Practice Address - Street 1:2055 LIMESTONE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5536
Practice Address - Country:US
Practice Address - Phone:302-999-8169
Practice Address - Fax:302-999-8190
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001082001Medicaid
00A778D57Medicare ID - Type Unspecified
DEG02723I05Medicare PIN
H49632Medicare UPIN