Provider Demographics
NPI:1700967692
Name:CASTILLO, JAMES GLENN (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GLENN
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:5450 FRANTZ RD STE 360
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4141
Mailing Address - Country:US
Mailing Address - Phone:614-533-6497
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:130 MORRIS RD
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1362
Practice Address - Country:US
Practice Address - Phone:740-477-6511
Practice Address - Fax:740-477-6888
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2022-06-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH50000759363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0067382Medicaid