MEDICARE: DR. DAVID J SANSOTERRA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	35.076193	OH

General Provider Information

NPI Number	:	1952301715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID J SANSOTERRA M.D.

Provider Business Mailing Address
First Line	:	1 PERKINS SQ
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44308-1063
Country	:	US
Telephone Number	:	330-746-9200
Fax Number	:	330-746-9201

Provider Business Practice Location Address
First Line	:	6505 MARKET ST
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512-3457
Country	:	US
Telephone Number	:	330-746-9200
Fax Number	:	330-746-9201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	02/06/2017

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