Healthcare Provider Details

I. General information

NPI: 1952301715
Provider Name (Legal Business Name): DAVID J SANSOTERRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 MARKET ST
BOARDMAN OH
44512-3457
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-746-9200
  • Fax: 330-746-9201
Mailing address:
  • Phone: 330-746-9200
  • Fax: 330-746-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number35.076193
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: