=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881655546
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIO ESTOLANO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2006
-----------------------------------------------------
Last Update Date | 01/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1106 COLEGATE DR EMERGENCY DEPT
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45750-1323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-562-2000
-----------------------------------------------------
Fax | 740-568-2096
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 447
-----------------------------------------------------
City | ALLISON PARK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15101-0447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-487-3556
-----------------------------------------------------
Fax | 412-486-6605
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | MD042124E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 18489
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 35.085260
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------