Provider Demographics
NPI:1477901718
Name:CASTRO, ANGEL ERNESTO (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:ERNESTO
Last Name:CASTRO
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:226 MILL HILL AVE, 3RD FL
Mailing Address - Street 2:C/O NORTHEAST MEDICAL GROUP, INC.
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2826
Mailing Address - Country:US
Mailing Address - Phone:203-789-4140
Mailing Address - Fax:203-789-6617
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:VERDI 3 SOUTH 3021
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-4140
Practice Address - Fax:203-789-6617
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT3618363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical