Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 150763 | MA |
N | 208600000X | Surgeon | 150763 | MA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 150763 | MA |
NPI | 1033193289 |
---|---|
Provider Name | Dr. John M Castle |
First Address | Boston, MA 02241-0001 |
Second Address | Worcester, MA 01605-2138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 02/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110057172A | (05) | MA |
G26708 | (02) | MA |