Provider Demographics
NPI:1881655546
Name:ESTOLANO, MARIO (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:ESTOLANO
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:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-0447
Mailing Address - Country:US
Mailing Address - Phone:412-487-3556
Mailing Address - Fax:412-486-6605
Practice Address - Street 1:1106 COLEGATE DR EMERGENCY DEPT
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1323
Practice Address - Country:US
Practice Address - Phone:740-562-2000
Practice Address - Fax:740-568-2096
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042124E207P00000X
WV18489207R00000X
OH35.085260207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001216525Medicaid
OH2894855Medicaid
WV0078795000Medicaid
OHP01009794OtherRRMCR
OHH054150Medicare PIN
PA622803Medicare ID - Type Unspecified
WV0078795000Medicaid