Provider Demographics
NPI:1306816921
Name:SATRIALE, RICHARD FAUST (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:FAUST
Last Name:SATRIALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13940 N US HIGHWAY 441 STE 102
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8909
Mailing Address - Country:US
Mailing Address - Phone:352-751-9900
Mailing Address - Fax:844-388-6186
Practice Address - Street 1:13940 N US HIGHWAY 441 STE 102
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8909
Practice Address - Country:US
Practice Address - Phone:352-751-9900
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 036097E207R00000X
FLME148969207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
04-08154OtherUNITED HEALTH CARE/EVERCA
PA1077833Medicaid
PA425891Medicare ID - Type Unspecified
PA1077833Medicaid