Individual
MR. BERNARD CASTONGUAY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
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
Update your record
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