Provider Demographics
NPI:1972678340
Name:SOTELO, AUGUSTO (MD)
Entity Type:Individual
Prefix:
First Name:AUGUSTO
Middle Name:
Last Name:SOTELO
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 1:235 HUMPHREY ROAD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601
Mailing Address - Country:US
Mailing Address - Phone:724-838-8818
Mailing Address - Fax:724-838-1791
Practice Address - Street 1:235 HUMPHREY ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-838-8818
Practice Address - Fax:724-838-1791
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030968L207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006034260001Medicaid
PA0006034260001Medicaid
B34679Medicare UPIN