MEDICARE: RONALD P. SANTASIERO MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	127739	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00010157102	OTHER	NY	UNIVERA HEALTHCARE

General Provider Information

NPI Number	:	1396933834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD P. SANTASIERO MD PC

Provider Business Mailing Address
First Line	:	4535 SOUTHWESTERN BLVD
Second Line	:	SUITE 801
City	:	HAMBURG
State	:	NY
Zip	:	14075-1860
Country	:	US
Telephone Number	:	716-646-6075
Fax Number	:	716-646-5912

Provider Business Practice Location Address
First Line	:	4535 SOUTHWESTERN BLVD
Second Line	:	SUITE 801
City	:	HAMBURG
State	:	NY
Zip	:	14075-1860
Country	:	US
Telephone Number	:	716-646-6075
Fax Number	:	716-646-5912

Authorized Official
Title or Position	:	OWNER
Name	:	RONALD P SANTASIERO
Credential	:	MD
Telephone Number	:	716-646-6075

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	03/20/2015

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