Basic Information
| Provider Information | |||||||||
| NPI: | 1881655546 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESTOLANO | ||||||||
| FirstName: | MARIO | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 447 | ||||||||
| Address2: | |||||||||
| City: | ALLISON PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151010447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124873556 | ||||||||
| FaxNumber: | 4124866605 | ||||||||
| Practice Location | |||||||||
| Address1: | 799 FARSON ST EMERGENCY DEPT | ||||||||
| Address2: | |||||||||
| City: | BELPRE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457141044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404011150 | ||||||||
| FaxNumber: | 7404011155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 04/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD042124E | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 18489 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | 35.085260 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.