Provider Demographics
NPI:1891751319
Name:STANKO, JOHN JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:STANKO
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 1:147 SCHOOLHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1214
Mailing Address - Country:US
Mailing Address - Phone:614-996-8011
Mailing Address - Fax:614-996-8015
Practice Address - Street 1:147 SCHOOLHOUSE LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1214
Practice Address - Country:US
Practice Address - Phone:614-996-8011
Practice Address - Fax:614-996-8015
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-2140207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2069989Medicaid
OH2069989Medicaid
OH0827108Medicare PIN