Provider Demographics
NPI:1295739670
Name:CASTONGUAY, BERNARD JR (PT)
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:
Last Name:CASTONGUAY
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 STATE ST
Mailing Address - Street 2:STE 400
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6623
Mailing Address - Country:US
Mailing Address - Phone:207-942-7630
Mailing Address - Fax:207-942-5686
Practice Address - Street 1:404 STATE ST
Practice Address - Street 2:STE 400
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6623
Practice Address - Country:US
Practice Address - Phone:207-942-7630
Practice Address - Fax:207-942-5686
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2184225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME040538OtherANTHEM BCBS ID#
ME2627810OtherAETNA INDIVIDUAL PROVIDER ID
ME259740099OtherMAINECARE INDIVIDUAL
MEUX7440Medicare PIN