Provider Demographics
NPI:1689694952
Name:SANITATO, JOHN JOSEPH JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:SANITATO
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 1:6900 PEARL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3640
Mailing Address - Country:US
Mailing Address - Phone:216-844-2400
Mailing Address - Fax:216-292-1001
Practice Address - Street 1:6900 PEARL RD STE 100
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3640
Practice Address - Country:US
Practice Address - Phone:216-844-2400
Practice Address - Fax:216-292-1001
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0751482084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH260050789OtherRAILROAD MEDICARE
OH000000532988OtherANTHEM
OH4007873OtherAETNA
OH2316505Medicaid
OH000000532988OtherANTHEM
OHSA4073341Medicare ID - Type Unspecified
OH260050789OtherRAILROAD MEDICARE