Provider Demographics
NPI:1093793283
Name:CASTILLO, REBECCA APPLETON (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:APPLETON
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:PO BOX 405838
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5838
Mailing Address - Country:US
Mailing Address - Phone:704-660-4551
Mailing Address - Fax:704-660-4106
Practice Address - Street 1:538 WILLIAMSON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-7610
Practice Address - Country:US
Practice Address - Phone:704-664-4247
Practice Address - Fax:704-799-7812
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891240AMedicaid
NC891240AMedicaid
NC2278348CMedicare PIN