Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0101X | MOHS-Micrographic Surgeon | MD066026L | PA |
Y | 207NS0135X | Procedural Dermatology | MD066026L | PA |
NPI | 1164454237 |
---|---|
Provider Name | Anthony F. Santoro |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19111-2434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 06/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H11913 | (02) | PA |