Provider Demographics
NPI:1669543906
Name:SITARIK, JOSEPH P (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:SITARIK
Suffix:
Gender:M
Credentials:DO
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 2774
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-0774
Mailing Address - Country:US
Mailing Address - Phone:330-386-6800
Mailing Address - Fax:330-386-4219
Practice Address - Street 1:16844 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-4277
Practice Address - Country:US
Practice Address - Phone:330-386-6800
Practice Address - Fax:330-386-4219
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004441208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000113604OtherANTHEM
OH0764776Medicaid
WV0125021000Medicaid
020014801Medicare ID - Type UnspecifiedUHC RR MEDICARE
E48124Medicare UPIN
OHSI0662242Medicare ID - Type Unspecified