Provider Demographics
NPI:1124051750
Name:SANTORO, ANTONIO (PA)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:SANTORO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 COPPERMILL RD
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4013
Mailing Address - Country:US
Mailing Address - Phone:860-563-0115
Mailing Address - Fax:
Practice Address - Street 1:BRISTOL HOSPITAL, BREWSTER RD.
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06011-0977
Practice Address - Country:US
Practice Address - Phone:860-585-3528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000088363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
290000088CT01OtherANTHEM BC & BS
CTS98228Medicare UPIN