Provider Demographics
NPI:1134133796
Name:CASTO, JEFFERSON PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:PATRICK
Last Name:CASTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 SKYLAR DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9359
Mailing Address - Country:US
Mailing Address - Phone:304-793-2059
Mailing Address - Fax:304-793-2537
Practice Address - Street 1:157 SKYLAR DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9359
Practice Address - Country:US
Practice Address - Phone:304-793-2059
Practice Address - Fax:304-793-2537
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18855208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV98727OtherUNICARE
001866321OtherBCBS MOUNTAIN STATE
WV7343786OtherAETNA
WV030778100OtherFEDERAL BLACK LUNG
WV1071574OtherBRICKSTREET (WV COMP)
WV3810005643Medicaid
WV98727OtherUNICARE
WVI47107Medicare UPIN
WV3810005643Medicaid