Healthcare Provider Details

I. General information

NPI: 1497776207
Provider Name (Legal Business Name): LAURELDALE FAMILY MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 KUTZTOWN RD
LAURELDALE PA
19605-2661
US

IV. Provider business mailing address

3212 KUTZTOWN RD
LAURELDALE PA
19605-2661
US

V. Phone/Fax

Practice location:
  • Phone: 610-929-3380
  • Fax: 610-685-9290
Mailing address:
  • Phone: 610-929-3380
  • Fax: 610-685-9290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM SANTORO
Title or Position: OWNER, PRESIDENT
Credential:
Phone: 610-929-3380