Healthcare Provider Details

I. General information

NPI: 1629713110
Provider Name (Legal Business Name): RICHARD M KASTELIC MD & ASSOC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 WARREN ST STE 300
JOHNSTOWN PA
15905-3443
US

IV. Provider business mailing address

322 WARREN ST STE 300
JOHNSTOWN PA
15905-3443
US

V. Phone/Fax

Practice location:
  • Phone: 724-201-6472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MICHAEL A KASTELIC
Title or Position: DIRECTOR
Credential:
Phone: 814-955-0400