Provider Demographics
NPI:1740287788
Name:CASTELLO, ALLEN RANDALL (MD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:RANDALL
Last Name:CASTELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1173 BLACKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4518
Mailing Address - Country:US
Mailing Address - Phone:407-877-4458
Mailing Address - Fax:407-877-4494
Practice Address - Street 1:1173 BLACKWOOD AVE
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4518
Practice Address - Country:US
Practice Address - Phone:407-877-4458
Practice Address - Fax:407-877-4494
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0056679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE78977Medicare UPIN
FL10227ZMedicare PIN
FL110243396Medicare PIN