Provider Demographics
NPI:1417035338
Name:CASILLAS-ROMERO, SERGIO R (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:R
Last Name:CASILLAS-ROMERO
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 1:112 LAFAYETTE STREET
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-425-8735
Mailing Address - Fax:
Practice Address - Street 1:12 CASE ST
Practice Address - Street 2:SUITE 313
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2222
Practice Address - Country:US
Practice Address - Phone:860-204-9126
Practice Address - Fax:860-204-9146
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT41831208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3V1171OtherHEALTHNET
CT010041831CT02OtherANTHEM
CT1417035338Medicaid
CTD400002154Medicare PIN