Provider Demographics
NPI:1205868668
Name:SANTIONI, MARIANNE J (DO)
Entity type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:J
Last Name:SANTIONI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:821 S MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1431
Mailing Address - Country:US
Mailing Address - Phone:570-457-0562
Mailing Address - Fax:570-457-0603
Practice Address - Street 1:821 S MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1431
Practice Address - Country:US
Practice Address - Phone:570-457-0562
Practice Address - Fax:570-457-0603
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-09-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS007763L207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA16104990001Medicaid
072359Medicare ID - Type Unspecified
PA16104990001Medicaid