Provider Demographics
NPI:1124015219
Name:SESTAK, DAVID ANTHONY (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANTHONY
Last Name:SESTAK
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 1:1105 SCHROCK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1146
Mailing Address - Country:US
Mailing Address - Phone:614-505-7633
Mailing Address - Fax:
Practice Address - Street 1:1100 SUNBURY RD
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-6040
Practice Address - Country:US
Practice Address - Phone:740-363-3133
Practice Address - Fax:740-363-3135
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004956207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E76392Medicare UPIN
E76392Medicare UPIN