Provider Demographics
NPI:1548818602
Name:SANTROCK, DYLAN THOMAS (PA-C)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:THOMAS
Last Name:SANTROCK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:NESQUEHONING
Mailing Address - State:PA
Mailing Address - Zip Code:18240-1709
Mailing Address - Country:US
Mailing Address - Phone:908-763-2928
Mailing Address - Fax:
Practice Address - Street 1:700 E NORWEGIAN ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2710
Practice Address - Country:US
Practice Address - Phone:570-621-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical