Provider Demographics
NPI:1013992759
Name:SARTOR, NICHOLO J (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLO
Middle Name:J
Last Name:SARTOR
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 1:1801 LEE RD STE 165
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2127
Mailing Address - Country:US
Mailing Address - Phone:407-975-0410
Mailing Address - Fax:407-975-0413
Practice Address - Street 1:1801 LEE RD STE 165
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789
Practice Address - Country:US
Practice Address - Phone:407-975-0410
Practice Address - Fax:407-975-0413
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113841208000000X, 207R00000X, 208M00000X
NC9801478207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006567700Medicaid
NC370016486OtherRAILROAD MEDICARE
FLGP476XOtherMEDICARE
FLME113841OtherLICENSE
NC1167POtherBCBS OF NC
NC82667OtherMEDCOST INSURANCE
NC891167PMedicaid
NC891167PMedicaid