Provider Demographics
NPI:1518063718
Name:CASTRO, FERNANDO XAVIER (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:XAVIER
Last Name:CASTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FERNANDO
Other - Middle Name:XAVIER
Other - Last Name:CASTRO-GALLARDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:146 E HOSPITAL DR
Practice Address - Street 2:SUITE 550
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169
Practice Address - Country:US
Practice Address - Phone:803-936-7410
Practice Address - Fax:803-936-7412
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005020365207R00000X
NC2010-01637207RR0500X
SC36364207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1518063718OtherNPI