Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 59004 | OH |
NPI | 1104867464 |
---|---|
Provider Name | Philip Santa-Emma |
First Address | Dublin, OH 43017-8256 |
Second Address | Columbus, OH 43215-1039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 26/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080143171 | RAILROAD MEDICARE PIN (01) | OH |
0838697 | (05) | OH |
E75608 | (02) | OH |