1689655698 NPI number — DR. CHESTER NICHOLAS CASTER M.D.

Table of content: DR. CHESTER NICHOLAS CASTER M.D. (NPI 1689655698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689655698 NPI number — DR. CHESTER NICHOLAS CASTER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTER
Provider First Name:
CHESTER
Provider Middle Name:
NICHOLAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1689655698
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4017 RYAN PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHENECTADY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12303-2819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-357-0407
Provider Business Mailing Address Fax Number:
518-872-9265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1772 HELDERBERG TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERNE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12023-2709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-872-9262
Provider Business Practice Location Address Fax Number:
518-872-9265
Provider Enumeration Date:
11/08/2005

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: 207Q00000X , with the licence number:  197059 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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