Healthcare Provider Details

I. General information

NPI: 1649468646
Provider Name (Legal Business Name): ANTHONY W. CASTO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 SOMERSET BLVD SUITE 101
CHARLES TOWN WV
25414-3952
US

IV. Provider business mailing address

912 SOMERSET BLVD SUITE 101
CHARLES TOWN WV
25414-3952
US

V. Phone/Fax

Practice location:
  • Phone: 304-725-2663
  • Fax: 304-724-0053
Mailing address:
  • Phone: 304-725-2663
  • Fax: 304-724-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA056845
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2003
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2007030779
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2007030779
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: