Provider Demographics
NPI:1467995126
Name:CASTELLANOS, KATHLEEN INGRAHAM (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:INGRAHAM
Last Name:CASTELLANOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:JOY
Other - Last Name:INGRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1480 MCGUIRE RD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-3634
Mailing Address - Country:US
Mailing Address - Phone:205-979-0302
Mailing Address - Fax:205-979-2270
Practice Address - Street 1:1480 MCGUIRE RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-3634
Practice Address - Country:US
Practice Address - Phone:205-979-0302
Practice Address - Fax:205-979-2270
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.27279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine