1821471327 NPI number — WILHELM LEONARD CASTELLON

Table of content: WILHELM LEONARD CASTELLON (NPI 1821471327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821471327 NPI number — WILHELM LEONARD CASTELLON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTELLON
Provider First Name:
WILHELM
Provider Middle Name:
LEONARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1821471327
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
513 RIDGEWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHIPPENVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16254-4004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 DOCTORS LN
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
CLARION
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16214-8568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-226-2500
Provider Business Practice Location Address Fax Number:
814-226-2501
Provider Enumeration Date:
07/01/2015

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: 207R00000X , with the licence number:  U2802 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: OT016669 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com