Provider Demographics
NPI:1558794990
Name:SANTOS, MEINARDO III (PA)
Entity Type:Individual
Prefix:
First Name:MEINARDO
Middle Name:
Last Name:SANTOS
Suffix:III
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 BRASS CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-6309
Mailing Address - Country:US
Mailing Address - Phone:908-835-1910
Mailing Address - Fax:908-835-1924
Practice Address - Street 1:2571 BAGLYOS CIR
Practice Address - Street 2:SUITE B-29
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8045
Practice Address - Country:US
Practice Address - Phone:610-252-2222
Practice Address - Fax:610-252-0223
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA056220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant