Provider Demographics
NPI:1952301715
Name:SANSOTERRA, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:SANSOTERRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-746-9200
Mailing Address - Fax:330-746-9201
Practice Address - Street 1:6505 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3457
Practice Address - Country:US
Practice Address - Phone:330-746-9200
Practice Address - Fax:330-746-9201
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0761932080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2138510Medicaid