Healthcare Provider Details

I. General information

NPI: 1679606602
Provider Name (Legal Business Name): JOSE MICHAEL CASTEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 KUTZTOWN RD # B
LAURELDALE PA
19605-2661
US

IV. Provider business mailing address

1346 CORY DR
FORT WASHINGTON PA
19034-1643
US

V. Phone/Fax

Practice location:
  • Phone: 610-921-2384
  • Fax: 610-921-1944
Mailing address:
  • Phone: 215-643-2133
  • Fax: 215-643-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number035046-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: