Healthcare Provider Details

I. General information

NPI: 1265482566
Provider Name (Legal Business Name): DOCTORS HOUSE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 5TH STREET
ST ALBANS WV
25177-2858
US

IV. Provider business mailing address

612 5TH STREET
ST. ALBANS WV
25177-2858
US

V. Phone/Fax

Practice location:
  • Phone: 304-729-0015
  • Fax: 304-729-0016
Mailing address:
  • Phone: 304-729-0015
  • Fax: 304-729-0016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AMY DALE CASTO
Title or Position: OWNER/DOCTOR
Credential: D.O.
Phone: 304-729-0015