Provider Demographics
NPI:1619319985
Name:CASTRO, JACK (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:CASTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1921 HICKORY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-7333
Mailing Address - Country:US
Mailing Address - Phone:646-755-5476
Mailing Address - Fax:570-221-6246
Practice Address - Street 1:2300 PENNSYLVANIA AVE STE 4C
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1338
Practice Address - Country:US
Practice Address - Phone:646-755-5476
Practice Address - Fax:570-221-6246
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00123052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty