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Individual

DAVID CUSTODIO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
525 E MARKET ST, AKRON, OH 44304-1619
(330) 375-3369
(330) 375-6769
Mailing address
PO BOX 1649, AKRON, OH 44309-1649
(330) 864-8900
(330) 869-8924

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35059419C
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000138484
ANTHEM
OH
05
0792923
OH
01
340714755EEE
SUMMACARE
OH
01
34177922602
MEDICAL MUTUAL OF OH 1 /2
OH
01
34177922603
MED MUTUAL 2 OF 2
OH
01
61641
UNITED HEALTHCARE
OH
01
930023429
RR MEDICARE
OH
Enumeration date
05/26/2006
Last updated
03/04/2014
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