Provider Demographics
NPI:1760518682
Name:CASTILLO, AMY ASHLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ASHLEY
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:12201 PLUM ORCHARD DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7803
Practice Address - Country:US
Practice Address - Phone:301-572-1063
Practice Address - Fax:301-618-5673
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD31316208000000X
MDD54978208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H82151Medicare UPIN
011403M92Medicare ID - Type Unspecified