Provider Demographics
NPI:1144204546
Name:CASTILLA, ELIAS A (MD)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:A
Last Name:CASTILLA
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 632242
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2242
Mailing Address - Country:US
Mailing Address - Phone:800-503-6254
Mailing Address - Fax:
Practice Address - Street 1:10500 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4402
Practice Address - Country:US
Practice Address - Phone:513-745-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083219207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200396240CMedicaid
IN200396240EMedicaid
IN200396240DMedicaid
KY64098429Medicaid
OH2517995Medicaid
IN200225190AMedicaid
IN200396240AMedicaid
OHCA4142992Medicare ID - Type Unspecified
OHCA4142994Medicare ID - Type Unspecified
IN200225190AMedicaid
OHCA4142993Medicare ID - Type Unspecified
KY64098429Medicaid