Provider Demographics
NPI:1952764375
Name:NESTASIE, MICHAEL JAMES (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:NESTASIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1624 PACIFIC AVE STE B
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2145
Mailing Address - Country:US
Mailing Address - Phone:724-226-3345
Mailing Address - Fax:724-226-2415
Practice Address - Street 1:1624 PACIFIC AVE STE B
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2145
Practice Address - Country:US
Practice Address - Phone:724-226-3345
Practice Address - Fax:724-226-2415
Is Sole Proprietor?:No
Enumeration Date:2016-04-02
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019962207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2X4087OtherMEDICARE
PA1101140177OtherPA MEDICAID