Provider Demographics
NPI:1821042417
Name:RICHARD M KASTELIC MD & ASSOC PC
Entity Type:Organization
Organization Name:RICHARD M KASTELIC MD & ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KASTELIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-288-1418
Mailing Address - Street 1:322 WARREN ST
Mailing Address - Street 2:STE 300
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-3443
Mailing Address - Country:US
Mailing Address - Phone:814-288-4498
Mailing Address - Fax:814-288-5427
Practice Address - Street 1:322 WARREN ST
Practice Address - Street 2:STE 300
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-3437
Practice Address - Country:US
Practice Address - Phone:814-288-4498
Practice Address - Fax:814-288-5427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040121L207Q00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007743550005Medicaid
PA1007743550007Medicaid
PA037937Medicare ID - Type Unspecified