Provider Demographics
NPI:1083828032
Name:CASTILLO, MARIGOLD C (MD)
Entity Type:Individual
Prefix:
First Name:MARIGOLD
Middle Name:C
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 1:4205 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2573
Mailing Address - Country:US
Mailing Address - Phone:718-631-2273
Mailing Address - Fax:718-631-2278
Practice Address - Street 1:4205 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2573
Practice Address - Country:US
Practice Address - Phone:718-631-2273
Practice Address - Fax:718-631-2278
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2658872080A0000X
CT0478842080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine