Basic Information
| Provider Information | |||||||||
| NPI: | 1558794990 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTOS | ||||||||
| FirstName: | MEINARDO | ||||||||
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| NameSuffix: | III | ||||||||
| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 BRASS CASTLE RD | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078826309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9088351910 | ||||||||
| FaxNumber: | 9088351924 | ||||||||
| Practice Location | |||||||||
| Address1: | 2571 BAGLYOS CIR | ||||||||
| Address2: | SUITE B-29 | ||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180208045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102522222 | ||||||||
| FaxNumber: | 6102520223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2013 | ||||||||
| LastUpdateDate: | 08/20/2013 | ||||||||
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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 | 363A00000X | MA056220 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.