Basic Information
| Provider Information | |||||||||
| NPI: | 1568012839 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RICHARD M. KASTELIC, MD & ASSOC., P.C./SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 322 WARREN STREET | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159053443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142884498 | ||||||||
| FaxNumber: | 8142881525 | ||||||||
| Practice Location | |||||||||
| Address1: | 322 WARREN STREET | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159053443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142884498 | ||||||||
| FaxNumber: | 8142881525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2019 | ||||||||
| LastUpdateDate: | 09/18/2019 | ||||||||
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| AuthorizedOfficialLastName: | KASTELIC | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8142884498 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RICHARD M. KASTELIC, MD & ASSOC., P.C | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 2085R0202X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 208VP0014X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 213E00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.