Provider Demographics
NPI:1114450228
Name:SAONA CENTENO, JORGE EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:EDUARDO
Last Name:SAONA CENTENO
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 BORTHWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7128
Mailing Address - Country:US
Mailing Address - Phone:603-433-6931
Mailing Address - Fax:
Practice Address - Street 1:333 BORTHWICK AVE STE 100
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4198
Practice Address - Country:US
Practice Address - Phone:561-965-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2020-09-15
Deactivation Date:2017-11-09
Deactivation Code:
Reactivation Date:2017-11-14
Provider Licenses
StateLicense IDTaxonomies
390200000X
NH20420208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program