1942250535 NPI number — DR. VINCENT M SANTORO MD

Table of content: DR. VINCENT M SANTORO MD (NPI 1942250535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942250535 NPI number — DR. VINCENT M SANTORO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTORO
Provider First Name:
VINCENT
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1942250535
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 BOREN AVE
Provider Second Line Business Mailing Address:
#800
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98104-3534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-323-1900
Provider Business Mailing Address Fax Number:
206-323-6868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12333 NE 130TH LANE
Provider Second Line Business Practice Location Address:
#400
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-7467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-323-1900
Provider Business Practice Location Address Fax Number:
206-323-6868
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X , with the licence number:  MD00025701 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2356SA . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2356SA . This is a "REGENCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0204542 . This is a "WA STATE LABOR & INDUST" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0204542 . This is a "L & I" identifier . This identifiers is of the category "OTHER".




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