Provider Demographics
NPI:1467447193
Name:CASTRO, CARLOS ALBERTO (MD)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:ALBERTO
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:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-0099
Mailing Address - Country:US
Mailing Address - Phone:518-235-3990
Mailing Address - Fax:518-235-9177
Practice Address - Street 1:190 5TH AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1017
Practice Address - Country:US
Practice Address - Phone:518-235-3990
Practice Address - Fax:518-235-9177
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1271531208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000406487001OtherBSNENY
NY00942663Medicaid
NY10000297OtherCDPHP
NY10000297OtherCDPHP
NY000406487001OtherBSNENY