Provider Demographics
NPI:1316032097
Name:POTESTA, EUGENE L JR (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:L
Last Name:POTESTA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7227 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4853
Mailing Address - Country:US
Mailing Address - Phone:330-629-2144
Mailing Address - Fax:330-629-2140
Practice Address - Street 1:7227 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4853
Practice Address - Country:US
Practice Address - Phone:330-629-2144
Practice Address - Fax:330-629-2140
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.059991207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000127501OtherUNICARE
Z59991OtherSUMMACARE
OH000000127501OtherANTHEM PIN
OH10-0016OtherUHC PIN
170476OtherUNISON
OH1751176006OtherCIGNA
1507349OtherGATEWAY
OH0756534Medicaid
177763OtherKEYSTONE HEALTH PLAN
341112079029OtherCARESOURCE
0756534OtherBCMH
PO0705942Medicare PIN
0756534OtherBCMH
170476OtherUNISON
OH10-0016OtherUHC PIN