=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891041141
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LILLIANNE STANITSAS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2012
-----------------------------------------------------
Last Update Date | 08/14/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 COVINGTON ST
-----------------------------------------------------
City | YOUNGSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-480-2371
-----------------------------------------------------
Fax | 330-480-3970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 COVINGTON ST
-----------------------------------------------------
City | YOUNGSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44510-1617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-480-2371
-----------------------------------------------------
Fax | 330-480-3970
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 35.131821
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2086S0102X
-----------------------------------------------------
Taxonomy Name | Surgical Critical Care Physician
-----------------------------------------------------
License Number | 35.131821
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------