Healthcare Provider Details

I. General information

NPI: 1821471327
Provider Name (Legal Business Name): WILHELM LEONARD CASTELLON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 DOCTORS LN SUITE 202
CLARION PA
16214-8568
US

IV. Provider business mailing address

513 RIDGEWOOD RD
SHIPPENVILLE PA
16254-4004
US

V. Phone/Fax

Practice location:
  • Phone: 814-226-2500
  • Fax: 814-226-2501
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberU2802
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT016669
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: