Provider Demographics
NPI:1902034465
Name:CASTOR PRIMARY CARE LLC
Entity Type:Organization
Organization Name:CASTOR PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RALIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-535-5616
Mailing Address - Street 1:6044 CASTOR AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-3205
Mailing Address - Country:US
Mailing Address - Phone:215-535-5616
Mailing Address - Fax:215-535-5618
Practice Address - Street 1:6044 CASTOR AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-3205
Practice Address - Country:US
Practice Address - Phone:215-535-5616
Practice Address - Fax:215-535-5618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009718111N00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty