Provider Demographics
NPI:1952349771
Name:SAMMARTINO, JOHN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:SAMMARTINO
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 1:3019 GARRETT RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2216
Mailing Address - Country:US
Mailing Address - Phone:610-259-0400
Mailing Address - Fax:610-259-1165
Practice Address - Street 1:3019 GARRETT RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-2216
Practice Address - Country:US
Practice Address - Phone:610-259-0400
Practice Address - Fax:610-259-1165
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027377E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0031524OtherAETNA PROVIDER NUMBER
PA044719Medicare ID - Type UnspecifiedMEDICARE ID
PA0031524OtherAETNA PROVIDER NUMBER