Provider Demographics
NPI:1497758288
Name:CASTELLANO, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:CASTELLANO
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:ERPG EMERGENCY SERVICES
Mailing Address - Street 2:763 JOHNSONBURG RD
Mailing Address - City:ST. MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857
Mailing Address - Country:US
Mailing Address - Phone:814-888-8595
Mailing Address - Fax:814-888-8036
Practice Address - Street 1:ERPG EMERGENCY SERVICES
Practice Address - Street 2:763 JOHNSONBURG RD
Practice Address - City:ST. MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857
Practice Address - Country:US
Practice Address - Phone:814-888-8595
Practice Address - Fax:814-888-8036
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030146E207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0967902Medicaid
PA0967902Medicaid
PA423461Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #