Healthcare Provider Details

I. General information

NPI: 1962488478
Provider Name (Legal Business Name): LOUIS CASTERN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 MCDOWELL AVE NE STE B
ROANOKE VA
24016-1532
US

IV. Provider business mailing address

512 MCDOWELL AVE NE STE B
ROANOKE VA
24016-1532
US

V. Phone/Fax

Practice location:
  • Phone: 540-853-4200
  • Fax: 540-362-9659
Mailing address:
  • Phone: 540-853-4200
  • Fax: 540-362-9659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number0101034748
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: