Healthcare Provider Details

I. General information

NPI: 1013021666
Provider Name (Legal Business Name): NESTOR ESNAOLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST 4TH FL PARKINSON PAVILION
PHILADELPHIA PA
19140-5103
US

IV. Provider business mailing address

2450 W HUNTING PARK AVE 3/208N
PHILADELPHIA PA
19129-1302
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-3133
  • Fax: 215-707-3945
Mailing address:
  • Phone: 215-707-3133
  • Fax: 215-707-3945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number27549
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD446554
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: