Basic Information
Provider Information | |||||||||
NPI: | 1265616460 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | RICHARD M. KASTELIC, MD & ASSOC., P.C. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | BERKLEY HILLS MEDICAL PSYCHOLOGY | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 322 WARREN ST | ||||||||
Address2: | SUITE 300 | ||||||||
City: | JOHNSTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 159053443 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8142884498 | ||||||||
FaxNumber: | 8142885427 | ||||||||
Practice Location | |||||||||
Address1: | 322 WARREN ST | ||||||||
Address2: | SUITE 300 | ||||||||
City: | JOHNSTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 159053443 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8142884498 | ||||||||
FaxNumber: | 8142885427 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/24/2007 | ||||||||
LastUpdateDate: | 01/31/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KASTELIC | ||||||||
AuthorizedOfficialFirstName: | RICHARD | ||||||||
AuthorizedOfficialMiddleName: | M. | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 8142881418 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PS006299L | PA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |   |
ID Information
ID | Type | State | Issuer | Description | 1999942 | 01 | PA | HIGHMARK | OTHER |