Provider Demographics
NPI:1154321461
Name:CASTIGLIONE, CHARLES LEONARD (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:LEONARD
Last Name:CASTIGLIONE
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 1:399 FARMINGTON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1936
Mailing Address - Country:US
Mailing Address - Phone:860-548-7338
Mailing Address - Fax:860-524-2654
Practice Address - Street 1:399 FARMINGTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1936
Practice Address - Country:US
Practice Address - Phone:860-548-7338
Practice Address - Fax:860-524-2654
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024706208200000X, 2082S0099X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2017364OtherAETNA
CT010024706CT06OtherANTHEM BCBS
CT06-1406459OtherMULTIPLAN
CT11097OtherHEALTH NEW ENGLAND
CTP785356OtherOXFORD
CT001247065Medicaid
CT06-1406459OtherHMC, PPO
CT06-1406459OtherCORVEL
CT06-1406459OtherPRIVATE HEALTHCARE SYSTEM
CT06-1406459OtherNORTHEAST HEALTH DIRECT
CT06-1406459OtherCOLONIAL COOPERATIVE CARE
CT0188776 001OtherCIGNA
CT06-1406459OtherGREAT-WEST HEALTHCARE
CT06-1406459OtherUNITED HEALTHCARE
CT024706-1384OtherCONNECTICARE
CT06-1406459OtherFOCUS
CT0S2090OtherHEALTH NET
MA3163563OtherMASSHEALTH
240000111Medicare ID - Type Unspecified
CT06-1406459OtherCOLONIAL COOPERATIVE CARE