Provider Demographics
NPI:1255443115
Name:CASTALDO, RICHARD SCOTT (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:SCOTT
Last Name:CASTALDO
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 1:621 10TH ST
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1813
Mailing Address - Country:US
Mailing Address - Phone:716-278-4000
Mailing Address - Fax:
Practice Address - Street 1:621 TENTH STREET
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14302
Practice Address - Country:US
Practice Address - Phone:716-278-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188421-1207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0406737OtherINDEPENDENT HEALTH
NY00010026901OtherUNIVERA
NY000511327007OtherBLUE CROSS
NY01343911Medicaid
NY01343911Medicaid
NY110056410Medicare PIN
NY000511327007OtherBLUE CROSS