Provider Demographics
NPI:1326069691
Name:ROBERT A. SANTORA M.D.P.C
Entity Type:Organization
Organization Name:ROBERT A. SANTORA M.D.P.C
Other - Org Name:MEADVILLE OPTHALMOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEUPOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-724-5122
Mailing Address - Street 1:390 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3026
Mailing Address - Country:US
Mailing Address - Phone:814-724-5122
Mailing Address - Fax:814-724-8276
Practice Address - Street 1:390 LINDEN ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3026
Practice Address - Country:US
Practice Address - Phone:814-724-5122
Practice Address - Fax:814-724-8276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029837L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006183580002Medicaid
PA0455910001Medicare NSC
C31612Medicare UPIN