Provider Demographics
NPI:1578728507
Name:CASTELLO, MICHAEL GENE (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GENE
Last Name:CASTELLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:251 SALINA MEADOWS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4516
Mailing Address - Country:US
Mailing Address - Phone:315-464-2000
Mailing Address - Fax:315-464-2010
Practice Address - Street 1:750 EAST ADAMS ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-6106
Practice Address - Fax:315-464-6117
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102204338208800000X
VT032.0107285208800000X
WV2483208800000X
NY281091208800000X
IN02006181A208800000X
ND16732208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01216612OtherRAILROAD MEDICARE
P01216612OtherRAILROAD MEDICARE