Provider Demographics
NPI:1639198385
Name:CASTELLANOS, ADALBERTO ROMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ADALBERTO
Middle Name:ROMAN
Last Name:CASTELLANOS
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 1:1401 HARRODSBURG RD STE B355
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3747
Mailing Address - Country:US
Mailing Address - Phone:859-276-5262
Mailing Address - Fax:859-277-6509
Practice Address - Street 1:1780 NICHOLASVILLE RD STE 202
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1412
Practice Address - Country:US
Practice Address - Phone:859-260-5064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36158207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1106798OtherWELLCARE OF KY (MEDICAID)
KY1188015OtherCHA
KY2900152OtherUNITED HEALTHCARE
KY64039282Medicaid
KY100015197OtherRAILROAD MEDICARE
KY5436123OtherAETNA
KYC23066OtherCUMBERLAND HEALTH
KY000000185076OtherBCBS
KY922877OtherANTHEM BC/BS
KY5436123OtherAETNA
KYK033772Medicare PIN
KYK033771(KOHMG)Medicare PIN