Provider Demographics
NPI:1366616625
Name:LOUIS X SANTORE MD PC
Entity type:Organization
Organization Name:LOUIS X SANTORE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:X
Authorized Official - Last Name:SANTORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-642-4392
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:SUITE 36W
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-642-4392
Mailing Address - Fax:610-642-1948
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:SUITE 36W
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-642-4392
Practice Address - Fax:610-642-1948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD02689E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4088621OtherAETNA
PA2084353OtherHIGHMARK BLUE CROSS/BLUE SHIELD
PA3687038000OtherINDEPENDENCE BLUE CROSS/BLUE SHIELD
PA6480910001Medicare NSC
PA142340Medicare PIN