Provider Demographics
NPI:1356308654
Name:CASTELLONE, DAVID LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LOUIS
Last Name:CASTELLONE
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 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:213 W 4TH NORTH ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6541
Practice Address - Country:US
Practice Address - Phone:843-873-0681
Practice Address - Fax:843-873-2749
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC080090612OtherRR MEDICARE
SC115672Medicaid
SC115672Medicaid
SCE915707126Medicare PIN
SCAA44987499Medicare PIN
SCAA44985282Medicare PIN
SCAA44987006Medicare PIN
SC080090612OtherRR MEDICARE