Healthcare Provider Details

I. General information

NPI: 1487822573
Provider Name (Legal Business Name): MARIANNE J. SANTIONI, D.O., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 S MAIN ST SUITE 3
OLD FORGE PA
18518-1497
US

IV. Provider business mailing address

821 S MAIN ST SUITE 3
OLD FORGE PA
18518-1497
US

V. Phone/Fax

Practice location:
  • Phone: 570-457-0562
  • Fax:
Mailing address:
  • Phone: 570-457-0562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberOS007763L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MARIANNE J SANTIONI
Title or Position: PRESIDENT
Credential: D.O.
Phone: 570-457-0562