Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD457958 | PA |
N | 111NI0900X | Internist | MD457958 | PA |
N | 207RC0200X | Critical Care Medicine | MD457958 | PA |
Y | 207RP1001X | Pulmonary Disease | MD457958 | PA |
NPI | 1003259987 |
---|---|
Provider Name | Eduardo Dominguez Castillo |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19140-5103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2013 |
Last Update Date | 13/08/2020 |