Provider Demographics
NPI:1770629701
Name:RONALD M CASTONGUAY MD INC
Entity Type:Organization
Organization Name:RONALD M CASTONGUAY MD INC
Other - Org Name:ORTHOPAEDIC SURGERY INC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:CASTONGUAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-431-5353
Mailing Address - Street 1:7255 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3831
Mailing Address - Country:US
Mailing Address - Phone:559-431-5353
Mailing Address - Fax:
Practice Address - Street 1:7255 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3831
Practice Address - Country:US
Practice Address - Phone:559-431-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55167174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A551670Medicaid
CA200037156OtherRAILROAD MEDICARE
CA184324800OtherUSDL
CAZZZ17834ZMedicare PIN