1497877872 NPI number — DAVID ANTHONY CASTLE PA-C

Table of content: DAVID ANTHONY CASTLE PA-C (NPI 1497877872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497877872 NPI number — DAVID ANTHONY CASTLE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTLE
Provider First Name:
DAVID
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497877872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 KEISLER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27518-7069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-781-9078
Provider Business Mailing Address Fax Number:
919-719-0147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 AVIEMORE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINEHURST
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-350-8779
Provider Business Practice Location Address Fax Number:
919-350-8812
Provider Enumeration Date:
04/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  50.002492 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)