Provider Demographics
NPI:1053847772
Name:SANTORO, GWENN (MD)
Entity Type:Individual
Prefix:
First Name:GWENN
Middle Name:
Last Name:SANTORO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 ANDERSON PL
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1925 W ORANGE GROVE RD STE 302
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1152
Practice Address - Country:US
Practice Address - Phone:520-797-3888
Practice Address - Fax:520-797-2196
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ63219208000000X
NY304857-01208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics