Provider Demographics
NPI:1649468646
Name:CASTO, ANTHONY W (PA-C)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:W
Last Name:CASTO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 SOMERSET BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-3952
Mailing Address - Country:US
Mailing Address - Phone:304-725-2663
Mailing Address - Fax:304-724-0053
Practice Address - Street 1:912 SOMERSET BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-3952
Practice Address - Country:US
Practice Address - Phone:304-725-2663
Practice Address - Fax:304-724-0053
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007030779363AM0700X, 363AS0400X
PAMA056845363A00000X
WV2003363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA352708LN7Medicare PIN
MOP00835986Medicare PIN
MOT41000007Medicare PIN