Provider Demographics
NPI:1417315045
Name:CASTIGLIONI, GINA (PA-C)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:CASTIGLIONI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MLK JR BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1209
Mailing Address - Country:US
Mailing Address - Phone:508-757-1589
Mailing Address - Fax:508-756-5633
Practice Address - Street 1:100 MLK JR BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1209
Practice Address - Country:US
Practice Address - Phone:508-757-1589
Practice Address - Fax:508-756-5633
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5649363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant