Provider Demographics
NPI:1952336026
Name:CASTELLUCCI, ROBERT P (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:CASTELLUCCI
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 1:5875 BREMO ROAD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226
Mailing Address - Country:US
Mailing Address - Phone:804-282-9899
Mailing Address - Fax:804-282-2619
Practice Address - Street 1:5875 BREMO ROAD
Practice Address - Street 2:SUITE 501
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226
Practice Address - Country:US
Practice Address - Phone:804-282-9899
Practice Address - Fax:804-282-2619
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101038708207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5808600Medicaid
VA097991OtherANTHEM
B61370Medicare UPIN