Provider Demographics
NPI: | 1851393953 |
---|---|
Name: | STEINBERGER, SIDNEY J (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | SIDNEY |
Middle Name: | J |
Last Name: | STEINBERGER |
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: | 2708 CRAWFIS BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | FAIRLAWN |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44333-2850 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 330-869-6673 |
Mailing Address - Fax: | 330-864-3270 |
Practice Address - Street 1: | 2708 CRAWFIS BLVD |
Practice Address - Street 2: | |
Practice Address - City: | FAIRLAWN |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44333-2850 |
Practice Address - Country: | US |
Practice Address - Phone: | 330-869-6673 |
Practice Address - Fax: | 330-864-3270 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2005-06-02 |
Last Update Date: | 2010-11-08 |
Deactivation Date: | 2006-03-21 |
Deactivation Code: | |
Reactivation Date: | 2006-03-27 |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 35052873 | 207Y00000X, 207YS0123X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | |
No | 207YS0123X | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 0606231 | Medicaid | |
OH | 0606231 | Medicaid | |
OH | A16271 | Medicare UPIN |