Healthcare Provider Details

I. General information

NPI: 1366616625
Provider Name (Legal Business Name): LOUIS X SANTORE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE SUITE 36W
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

100 E LANCASTER AVE SUITE 36W
WYNNEWOOD PA
19096-3450
US

V. Phone/Fax

Practice location:
  • Phone: 610-642-4392
  • Fax: 610-642-1948
Mailing address:
  • Phone: 610-642-4392
  • Fax: 610-642-1948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD02689E
License Number StatePA

VIII. Authorized Official

Name: DR. LOUIS X SANTORE
Title or Position: OPHTHALMOLOGIST
Credential: M.D.
Phone: 610-642-4392