Provider Demographics
NPI:1871633297
Name:DAVID ANSTADT, INC.
Entity Type:Organization
Organization Name:DAVID ANSTADT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-395-2491
Mailing Address - Street 1:2512 E MARKET ST STE B
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6202
Mailing Address - Country:US
Mailing Address - Phone:330-395-2491
Mailing Address - Fax:330-392-6445
Practice Address - Street 1:2512 E MARKET ST STE B
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6202
Practice Address - Country:US
Practice Address - Phone:330-395-2491
Practice Address - Fax:330-392-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-040465207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0538430Medicaid
OH4037781Medicare ID - Type Unspecified