Provider Demographics
NPI:1083682223
Name:SANTOS, DAWN M (PA)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 G A R HWY
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-3906
Mailing Address - Country:US
Mailing Address - Phone:508-379-0012
Mailing Address - Fax:508-379-0777
Practice Address - Street 1:1738 GAR HWY
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-3906
Practice Address - Country:US
Practice Address - Phone:508-379-0012
Practice Address - Fax:508-379-0777
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1309363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP1640Medicare ID - Type Unspecified
MAP51348Medicare UPIN