Provider Demographics
NPI:1386642569
Name:SANTOS, MEINARDO DELROSARIO JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:MEINARDO
Middle Name:DELROSARIO
Last Name:SANTOS
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:411 DOGWOOD RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-7566
Mailing Address - Country:US
Mailing Address - Phone:570-476-6629
Mailing Address - Fax:570-476-6839
Practice Address - Street 1:411 DOGWOOD RD
Practice Address - Street 2:SUITE 102
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7566
Practice Address - Country:US
Practice Address - Phone:570-476-6629
Practice Address - Fax:570-476-6839
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASC003865L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU45700Medicare UPIN
PA455701SZUMedicare PIN