Healthcare Provider Details

I. General information

NPI: 1821042417
Provider Name (Legal Business Name): RICHARD M KASTELIC MD & ASSOC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 WARREN ST STE 300
JOHNSTOWN PA
15905-3437
US

IV. Provider business mailing address

322 WARREN ST STE 300
JOHNSTOWN PA
15905-3443
US

V. Phone/Fax

Practice location:
  • Phone: 814-288-4498
  • Fax: 814-288-5427
Mailing address:
  • Phone: 814-288-4498
  • Fax: 814-288-5427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD040121L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMD040121L
License Number StatePA

VIII. Authorized Official

Name: RICHARD M. KASTELIC
Title or Position: PRESIDENT
Credential: MD
Phone: 814-288-1418