Provider Demographics
NPI:1114587326
Name:SANTIAGO CARLO, AXEL JAVIER (MD)
Entity Type:Individual
Prefix:
First Name:AXEL
Middle Name:JAVIER
Last Name:SANTIAGO CARLO
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-2521
Mailing Address - Fax:717-260-3330
Practice Address - Street 1:2003 SPRINGWOOD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4836
Practice Address - Country:US
Practice Address - Phone:717-851-2521
Practice Address - Fax:717-260-3330
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD478791207Q00000X, 207QS0010X, 207Q00000X
PR022281208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine