Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 224055 | MA |
NPI | 1003825712 |
---|---|
Provider Name | Roniel M. Santos |
First Address | Pittsfield, MA 01201-4109 |
Second Address | Pittsfield, MA 01201-4109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
136821 | (02) | |
MA224055 | CDPHP (01) | |
P00275645 | MEDICARE RAILROAD CARRIER (01) |