Provider Demographics
NPI:1649293218
Name:SANTORA, ROBERT A (MDPC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:SANTORA
Suffix:
Gender:M
Credentials:MDPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3026
Mailing Address - Country:US
Mailing Address - Phone:814-724-5122
Mailing Address - Fax:814-724-8276
Practice Address - Street 1:390 LINDEN ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3026
Practice Address - Country:US
Practice Address - Phone:814-724-5122
Practice Address - Fax:814-724-8276
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029837L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006183580002Medicaid
PA0006183580002Medicaid
PAC31612Medicare UPIN