Provider Demographics
NPI:1023037678
Name:SANTOS, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:SANTOS
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 1:331 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-1738
Mailing Address - Country:US
Mailing Address - Phone:978-744-3499
Mailing Address - Fax:978-744-6576
Practice Address - Street 1:331 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-1738
Practice Address - Country:US
Practice Address - Phone:978-744-3499
Practice Address - Fax:978-744-6576
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30944207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2022664Medicaid
MAD28137Medicare ID - Type UnspecifiedMEDICARE
MA2022664Medicaid