Provider Demographics
NPI:1780628313
Name:CASTIELLO, ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:CASTIELLO
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 1:3560 MERIDIAN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1731
Mailing Address - Country:US
Mailing Address - Phone:360-527-4507
Mailing Address - Fax:360-527-9965
Practice Address - Street 1:111 S 12TH ST STE D
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4000
Practice Address - Country:US
Practice Address - Phone:360-734-2800
Practice Address - Fax:360-734-3818
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK192330207ZP0102X
KY46633207ZP0102X
TNMD40440207ZP0102X
WAIMLC.MD.61277913207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100158300Medicaid
KY4018201Medicare PIN
TN3403473Medicare PIN