Provider Demographics
NPI:1700804408
Name:CONSTANTINO, JOHN N (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:N
Last Name:CONSTANTINO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4511 FOREST PARK AVE
Mailing Address - Street 2:STE 4300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2138
Mailing Address - Country:US
Mailing Address - Phone:314-286-1700
Mailing Address - Fax:314-408-2756
Practice Address - Street 1:4444 FOREST PARK AVE
Practice Address - Street 2:STE 2600
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2212
Practice Address - Country:US
Practice Address - Phone:314-286-1700
Practice Address - Fax:314-286-1777
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-11-15
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Provider Licenses
StateLicense IDTaxonomies
MO1029242084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203679303Medicaid
MO203679303Medicaid
MO926100213Medicaid