Provider Demographics
NPI:1083640148
Name:SANTOS, REYNALDO (MD)
Entity Type:Individual
Prefix:
First Name:REYNALDO
Middle Name:
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 1:333 N OXFORD VALLEY RD
Mailing Address - Street 2:STE 510
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030-2629
Mailing Address - Country:US
Mailing Address - Phone:215-785-0145
Mailing Address - Fax:215-785-0161
Practice Address - Street 1:333 N OXFORD VALLEY RD
Practice Address - Street 2:SUITE 510
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-2624
Practice Address - Country:US
Practice Address - Phone:215-785-0145
Practice Address - Fax:215-785-0161
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD036585E207L00000X
NJ25MA04092200207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA22-1994560OtherHEALTH AMERICA/HEALTH ASSURANCE
NJ22-1994560OtherUNITED HEALTHCARE/OXFORD
PA22-1994560OtherGREAT WEST HEALTHCARE
PA2350852000OtherAMERIHEALTH
PA4187349OtherCIGNA
PA1939471OtherFIRST HEALTH NETWORK
PA2350852000OtherKEYSTONE HEALTH PLAN EAST
NJ22-1994560OtherFIRST MCO
NJ70685OtherPA BLUE SHIELD
PASA1676378OtherHIGHMARK TRAD. IND
PA1676378OtherPA BLUE SHIELD
PA1676378OtherPERSONAL CHOICE
PA22-1994560OtherUNITED HEALTHCARE/OXFORD
PA22-1994560OtherPROCURA MANAGEMENT
PAP00236558OtherRAILROAD MEDICARE
PA22-1994560OtherFIRST MCO
PA2350852000OtherKEYSTONE HEALTH PLAN EAST
PA081609GDNMedicare PIN
PA1676378OtherPERSONAL CHOICE
NJ22-1994560OtherUNITED HEALTHCARE/OXFORD