Basic Information
| Provider Information | |||||||||
| NPI: | 1619932514 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SATALOFF | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 219 N. BROAD STREET | ||||||||
| Address2: | 10TH FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191071506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157625530 | ||||||||
| FaxNumber: | 2157625540 | ||||||||
| Practice Location | |||||||||
| Address1: | 219 N. BROAD STREET | ||||||||
| Address2: | 10TH FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191071506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157625530 | ||||||||
| FaxNumber: | 2157625540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 11/23/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | MD018721E | PA | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207YX0901X | MD018721E | PA | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Otology & Neurotology |
ID Information
| ID | Type | State | Issuer | Description | 000889664 | 05 | PA | MEDICAID |