Individual
MR. BERNARD CASTONGUAY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
404 STATE ST, STE 400, BANGOR, ME 04401-6623
(207) 942-7630
(207) 942-5686
Mailing address
404 STATE ST, STE 400, BANGOR, ME 04401-6623
(207) 942-7630
(207) 942-5686
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2184
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040538
ANTHEM BCBS ID#
ME
01
—
259740099
MAINECARE INDIVIDUAL
ME
01
—
2627810
AETNA INDIVIDUAL PROVIDER ID
ME
Enumeration date
06/13/2005
Last updated
04/24/2008
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