Provider Demographics
NPI:1003825712
Name:SANTOS, RONIEL M (DO)
Entity Type:Individual
Prefix:
First Name:RONIEL
Middle Name:M
Last Name:SANTOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 NORTH ST
Mailing Address - Street 2:BERKSHIRE MEDICAL CENTER EMERGENCY DEPT
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4109
Mailing Address - Country:US
Mailing Address - Phone:413-447-2000
Mailing Address - Fax:413-447-2175
Practice Address - Street 1:725 NORTH ST
Practice Address - Street 2:BERKSHIRE MEDICAL CENTER EMERGENCY DEPT
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4109
Practice Address - Country:US
Practice Address - Phone:413-447-2000
Practice Address - Fax:413-447-2175
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224055207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00275645OtherMEDICARE RAILROAD CARRIER
MA224055OtherCDPHP
MA224055OtherCDPHP
136821Medicare UPIN