Provider Demographics
NPI:1548209166
Name:SANTORE, LOUIS X (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:X
Last Name:SANTORE
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 1:100 E LANCASTER AVE
Mailing Address - Street 2:SUITE 400 SOUTH
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-642-4392
Mailing Address - Fax:610-642-1948
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:SUITE 400 SOUTH
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-642-4392
Practice Address - Fax:610-642-1948
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026089E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016236100004Medicaid
PA0016236100004Medicaid
PA052050Medicare ID - Type Unspecified