Provider Demographics
NPI:1225029788
Name:FERNANDEZ-DEL-CASTILLO, CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:FERNANDEZ-DEL-CASTILLO
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 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-5644
Mailing Address - Fax:617-724-3383
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:WAC 336
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-5644
Practice Address - Fax:617-724-3383
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78466207RG0100X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ11634OtherBCBS MA
MA722156OtherTUFTS HEALTH PLAN
MA3081826Medicaid
MAJ11634Medicare ID - Type Unspecified
MA722156OtherTUFTS HEALTH PLAN