Healthcare Provider Details

I. General information

NPI: 1508942400
Provider Name (Legal Business Name): PREMIER CARE PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2642 ELM RD.
CORTLAND OH
44410
US

IV. Provider business mailing address

2642 ELM RD.
CORTLAND OH
44410
US

V. Phone/Fax

Practice location:
  • Phone: 330-841-5500
  • Fax: 330-841-5510
Mailing address:
  • Phone: 330-841-5500
  • Fax: 330-841-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID J SANSOTERRA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 330-841-5500