Provider Demographics
NPI:1336104900
Name:CASTRO, LUIS J (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:J
Last Name:CASTRO
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 1:21605 CORDOVA PL
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-4809
Mailing Address - Country:US
Mailing Address - Phone:315-703-5049
Mailing Address - Fax:
Practice Address - Street 1:18941 JOHN J WILLIAMS HWY
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-4404
Practice Address - Country:US
Practice Address - Phone:302-645-3010
Practice Address - Fax:302-645-3814
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2080361207V00000X, 207Q00000X
DEC1-0024063207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02002922Medicaid
080160127Medicare PIN
H09518Medicare UPIN
NY02002922Medicaid