Provider Demographics
NPI:1669416988
Name:GESTOSANI, ANTONIO T (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:T
Last Name:GESTOSANI
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 1:602 PARMALEE AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1653
Mailing Address - Country:US
Mailing Address - Phone:330-742-2100
Mailing Address - Fax:330-742-2107
Practice Address - Street 1:1044 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1006
Practice Address - Country:US
Practice Address - Phone:330-742-2100
Practice Address - Fax:330-742-2107
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-044132207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0633649Medicaid
OH0633649Medicaid
OHF08556Medicare UPIN