Provider Demographics
NPI:1265812499
Name:SANTORE, ARIEL NICHOLE (PA-C)
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:NICHOLE
Last Name:SANTORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ARIEL
Other - Middle Name:NICHOLE
Other - Last Name:MIDDLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:6850 LOWS RD
Practice Address - Street 2:STE 325
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8708
Practice Address - Country:US
Practice Address - Phone:570-784-5545
Practice Address - Fax:570-245-0240
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
PAOA003771363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2E4494OtherMEDICARE
PA1032160620001Medicaid