Provider Demographics
NPI:1184669558
Name:GAYOMALI, NESTOR G (MD)
Entity Type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:G
Last Name:GAYOMALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-0296
Mailing Address - Country:US
Mailing Address - Phone:440-934-5443
Mailing Address - Fax:440-934-1077
Practice Address - Street 1:5311 MEADOW LANE CT
Practice Address - Street 2:SUITE 3
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-1485
Practice Address - Country:US
Practice Address - Phone:440-934-5443
Practice Address - Fax:440-934-1077
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35074130207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH110231767OtherRR MEDICARE
OH2084284Medicaid
OH2084284Medicaid
OH0846622Medicare PIN