Provider Demographics
NPI:1144294182
Name:GALICIA-CASTILLO, MARISSA CAGANAP (MD)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:CAGANAP
Last Name:GALICIA-CASTILLO
Suffix:
Gender:F
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-7040
Mailing Address - Fax:757-446-7049
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-7040
Practice Address - Fax:757-446-7049
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101102563207RG0300X, 207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC063AGOtherBC/BS
VAPAROtherMULTIPLAN
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherCIGNA
VA451669OtherANTHEM
NC89063AGMedicaid
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VAPAROtherCORVEL/CORCARE
VAPAROtherVIRGINIA PREMIER HEALTH
VA-022OtherTRICARE/CHAMPUS
VA005839670Medicaid
VAPAROtherUSA MANAGED CARE
VA382619OtherUHC/MAMSI
VA27711OtherSENTARA/OPTIMA HEALTH
VAPAROtherAETNA
VAPAROtherMULTIPLAN
VAH34148Medicare UPIN
VA110219721Medicare PIN