Basic Information
| Provider Information | |||||||||
| NPI: | 1790947687 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RICHARD M. KASTELIC, MD & ASSOC., P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 322 WARREN ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159053443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142884498 | ||||||||
| FaxNumber: | 8142881525 | ||||||||
| Practice Location | |||||||||
| Address1: | 322 WARREN ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159053443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142884498 | ||||||||
| FaxNumber: | 8142881525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2008 | ||||||||
| LastUpdateDate: | 07/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | KASTELIC | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8142881418 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PS006299L | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 0017897070005 | 05 | PA | MEDICAID |