Provider Demographics
NPI:1134102627
Name:BALESTRINO, EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:BALESTRINO
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 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-756-2940
Mailing Address - Fax:724-756-8515
Practice Address - Street 1:296 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PETROLIA
Practice Address - State:PA
Practice Address - Zip Code:16050
Practice Address - Country:US
Practice Address - Phone:724-756-2940
Practice Address - Fax:724-756-8515
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006965L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012602650003Medicaid
PA0012602650003Medicaid
PA679424RN0Medicare PIN