MEDICARE: ANTHONY W. CASTO PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	2007030779	MO
2	363AS0400X	Surgical Physician Assistant	2007030779	MO
3	363A00000X	Physician Assistant	MA056845	PA
4	363A00000X	Physician Assistant	2003	WV

General Provider Information

NPI Number	:	1649468646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY W. CASTO PA-C

Provider Business Mailing Address
First Line	:	912 SOMERSET BLVD
Second Line	:	SUITE 101
City	:	CHARLES TOWN
State	:	WV
Zip	:	25414-3952
Country	:	US
Telephone Number	:	304-725-2663
Fax Number	:	304-724-0053

Provider Business Practice Location Address
First Line	:	912 SOMERSET BLVD
Second Line	:	SUITE 101
City	:	CHARLES TOWN
State	:	WV
Zip	:	25414-3952
Country	:	US
Telephone Number	:	304-725-2663
Fax Number	:	304-724-0053

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	01/09/2017

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