Provider Demographics
NPI:1326155102
Name:CASTILLO, GABRIELLA (MD)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
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 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3180
Mailing Address - Fax:812-242-3857
Practice Address - Street 1:422 POPLAR ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-4209
Practice Address - Country:US
Practice Address - Phone:812-242-3180
Practice Address - Fax:812-242-3857
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027710A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4062035OtherAETNA
INP00828495OtherRAILROAD MEDICARE
01379BOtherCIGNA
IL0160275009OtherILLINOIS PUBLIC AID
IN100251620BMedicaid
108911OtherHEALTHLINK
000000080106OtherANTHEM
INP00828495OtherRAILROAD MEDICARE
IN100251620BMedicaid
IN070001446Medicare PIN
IN856800Medicare PIN
108911OtherHEALTHLINK