Provider Demographics
NPI:1003920885
Name:SANTIANO, JESUS G (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:G
Last Name:SANTIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:POCOMOKE
Mailing Address - State:MD
Mailing Address - Zip Code:21851-1129
Mailing Address - Country:US
Mailing Address - Phone:410-957-1310
Mailing Address - Fax:410-957-3904
Practice Address - Street 1:100 8TH STREET
Practice Address - Street 2:
Practice Address - City:POCOMOKE
Practice Address - State:MD
Practice Address - Zip Code:21851-1129
Practice Address - Country:US
Practice Address - Phone:410-957-1310
Practice Address - Fax:410-957-3904
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0002556208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD043611900Medicaid
D70284Medicare UPIN
MD7299Medicare ID - Type Unspecified