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General NPI Number Information
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NPI Number | 1073545570
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Entity Type | Organization
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Legal Business Name | BRANDON CESTARIC FAMILY MEDICINE, PLLC
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | RR 1 BOX 62A
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City | RIPLEY
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State | WV
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Zip | 25271-9710
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Country | US
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Telephone | 304-373-0280
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Fax | 304-373-0281
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Provider Business Mailing Address
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Address Line | RR 1 BOX 62A
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City | RIPLEY
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State | WV
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Zip | 25271-9710
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Country | US
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Telephone | 304-373-0280
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Fax | 304-373-0281
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Authorized Official
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Title or Position | PHYSICIAN
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Name | BRANDON A. CESTARIC
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Credential | DO
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Telephone | 304-373-0280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1905
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License Number State | WV
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