Provider Demographics
NPI:1679866081
Name:VORSTER, SAREL JOHANNES (MD)
Entity Type:Individual
Prefix:
First Name:SAREL
Middle Name:JOHANNES
Last Name:VORSTER
Suffix:
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 1:762 S CLEVELAND MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3024
Mailing Address - Country:US
Mailing Address - Phone:330-665-4100
Mailing Address - Fax:330-665-6748
Practice Address - Street 1:762 S CLEVELAND MASSILLON RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3024
Practice Address - Country:US
Practice Address - Phone:330-665-4100
Practice Address - Fax:330-665-6748
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-097203207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID
OH3157579Medicaid
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI
OH3157579Medicaid