Provider Demographics
NPI:1023038742
Name:STELLATO, THOMAS A (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:STELLATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 SOUTH GREEN ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121
Mailing Address - Country:US
Mailing Address - Phone:216-297-3223
Mailing Address - Fax:216-297-3225
Practice Address - Street 1:1611 SOUTH GREEN ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121
Practice Address - Country:US
Practice Address - Phone:216-297-3223
Practice Address - Fax:216-297-3225
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-040257208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH364045OtherWELLCARE
OH000000621883OtherANTHEM
OH0421994Medicaid
OH364045OtherWELLCARE
A84013Medicare UPIN