Individual
PATRICK FRANCIS CASTELLANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1623 S WELLS AVE, MERIDIAN, ID 83642-5040
(208) 985-1399
(208) 955-6501
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 985-1399
(208) 955-6501
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA-224
ID
363AM0700X
Medical Physician Assistant
Primary
TLP-064
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2048070
—
WA
01
—
319254
LABOR & INDUSTRIES
WA
01
—
P01538158
RR MEDICARE
WA
Enumeration date
11/29/2007
Last updated
09/13/2016
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