Provider Demographics
NPI:1255322913
Name:TALUG, ESER (MD)
Entity Type:Individual
Prefix:
First Name:ESER
Middle Name:
Last Name:TALUG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ESER
Other - Middle Name:
Other - Last Name:TALUG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4076 HOLIDAY ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4076 HOLIDAY ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2513
Practice Address - Country:US
Practice Address - Phone:330-492-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-0119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0792898Medicaid
200203012OtherFEDERAL TAX ID
200203012OtherFEDERAL TAX ID
BT 2392102OtherDEA #