Provider Demographics
NPI:1255679957
Name:DUMLAO, ANACLETA CASTILLO (MD)
Entity Type:Individual
Prefix:
First Name:ANACLETA
Middle Name:CASTILLO
Last Name:DUMLAO
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 1:855 PIERMONT AV
Mailing Address - Street 2:
Mailing Address - City:PIERMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10968
Mailing Address - Country:US
Mailing Address - Phone:845-359-0408
Mailing Address - Fax:
Practice Address - Street 1:855 PIERMONT AV.
Practice Address - Street 2:
Practice Address - City:PIERMONT
Practice Address - State:NY
Practice Address - Zip Code:10968
Practice Address - Country:US
Practice Address - Phone:845-359-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAI69361Medicare PIN