Provider Demographics
NPI:1093783060
Name:CESTARIC, BRANDON AUGUST (DO)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:AUGUST
Last Name:CESTARIC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:WV
Mailing Address - Zip Code:26143-0609
Mailing Address - Country:US
Mailing Address - Phone:304-275-3301
Mailing Address - Fax:304-275-4798
Practice Address - Street 1:512A SOUTH CHURCH STREET
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-1616
Practice Address - Country:US
Practice Address - Phone:304-372-1033
Practice Address - Fax:304-373-0223
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.015445207Q00000X
WV1905207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1842022000Medicaid
P00403709OtherRAILROAD MEDICARE
WV3810010399Medicaid
OH2601590Medicaid
WV1073545570Medicare PIN
WVH87495Medicare UPIN
OH2601590Medicaid
CE4109246Medicare PIN