Provider Demographics
NPI:1689646812
Name:CASTELLI, JOSEPH W (MC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:W
Last Name:CASTELLI
Suffix:
Gender:M
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 MINNEQUA AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3734
Mailing Address - Country:US
Mailing Address - Phone:719-564-0660
Mailing Address - Fax:719-564-0037
Practice Address - Street 1:1501 COURT ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2720
Practice Address - Country:US
Practice Address - Phone:719-543-6755
Practice Address - Fax:719-583-2236
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD34780174400000X
CO47810207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO69385874Medicaid
TNH32922Medicare UPIN