Basic Information
| Provider Information | |||||||||
| NPI: | 1013992759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SARTOR | ||||||||
| FirstName: | NICHOLO | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 LEE RD STE 165 | ||||||||
| Address2: | |||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327892127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079750410 | ||||||||
| FaxNumber: | 4079750413 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 LEE RD STE 165 | ||||||||
| Address2: | |||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32789 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079750410 | ||||||||
| FaxNumber: | 4079750413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 07/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME113841 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 9801478 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 9801478 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | ME113841 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | ME113841 | FL | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 006567700 | 05 | FL | MEDICAID | 370016486 | 01 | NC | RAILROAD MEDICARE | OTHER | GP476X | 01 | FL | MEDICARE | OTHER | ME113841 | 01 | FL | LICENSE | OTHER | 1167P | 01 | NC | BCBS OF NC | OTHER | 82667 | 01 | NC | MEDCOST INSURANCE | OTHER | 891167P | 05 | NC | MEDICAID |