Provider Demographics
NPI:1700877446
Name:ESGUERRA, JORGE V (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:V
Last Name:ESGUERRA
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:P.O. BOX 72384
Mailing Address - Street 2:RADIOLOGY ASSOCIATES OF CANTON, INC.
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44192
Mailing Address - Country:US
Mailing Address - Phone:888-686-1837
Mailing Address - Fax:330-686-5928
Practice Address - Street 1:2600 6TH ST SW
Practice Address - Street 2:RADIOLOGY ASSOCIATES OF CANTON, INC.
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44711
Practice Address - Country:US
Practice Address - Phone:330-363-2842
Practice Address - Fax:330-580-5536
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35 04 1922E2085N0700X
OH35 04 1992E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0434122Medicaid
OH300074577OtherRAILROAD MEDICARE
OHC46433Medicare UPIN
OH0434122Medicaid