Provider Demographics
NPI:1093932691
Name:RIVERVIEW ENT CENTER OF CENTRAL OHIO
Entity Type:Organization
Organization Name:RIVERVIEW ENT CENTER OF CENTRAL OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASTELLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-681-8300
Mailing Address - Street 1:2405 N COLUMBUS ST STE 230
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8186
Mailing Address - Country:US
Mailing Address - Phone:740-681-8300
Mailing Address - Fax:
Practice Address - Street 1:2405 N COLUMBUS ST STE 230
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8186
Practice Address - Country:US
Practice Address - Phone:740-681-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPR9214207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty