Individual
BLAKE CASTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
169 ASHLEY AVENUE RM 202 MAIN HOSPITAL, MSC333, CHARLESTON, SC 29425
(843) 792-4638
Mailing address
169 ASHLEY AVENUE RM 202 MAIN HOSPITAL, MSC333, CHARLESTON, SC 29425
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD82875LL
SC
Other
Enumeration date
06/21/2019
Last updated
06/21/2019
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