Healthcare Provider Details

I. General information

NPI: 1548209166
Provider Name (Legal Business Name): LOUIS X SANTORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE SUITE 400 SOUTH
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

100 E LANCASTER AVE SUITE 400 SOUTH
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 NumberMD026089E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: