1578731972 NPI number — ROBERT SANTIAGO, MD, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578731972 NPI number — ROBERT SANTIAGO, MD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT SANTIAGO, MD, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578731972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
247 GLEN VILLAGE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POWELL
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43065-9677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-431-8869
Provider Business Mailing Address Fax Number:
614-431-9910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
396 PORTLAND WAY N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALION
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44833-1115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-462-5543
Provider Business Practice Location Address Fax Number:
419-462-2058
Provider Enumeration Date:
02/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
DIANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
614-431-8869

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  35-05-7517 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 35-05-7517 . This is a "OHIO MEDICAL LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: $$$$$$$$$ . This is a "SSN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0759362 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107669 . This is a "WORKER'S COMP. EMPL. RISK" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1720121213 . This is a "INDIVIDUAL (TYPE 1) NPI" identifier . This identifiers is of the category "OTHER".




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