Provider Demographics
NPI:1659339646
Name:SANTAMARINA, LEO (MD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:
Last Name:SANTAMARINA
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 1:711 LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1575
Mailing Address - Country:US
Mailing Address - Phone:215-257-8053
Mailing Address - Fax:215-258-5115
Practice Address - Street 1:711 LAWN AVE
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1575
Practice Address - Country:US
Practice Address - Phone:215-257-8053
Practice Address - Fax:215-258-5115
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042096L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000957801Medicaid
MD007668600Medicaid
F82088Medicare UPIN
DE004030Medicare ID - Type Unspecified