Provider Demographics
NPI:1114925484
Name:SANTOS, JOANN CLAYTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:CLAYTON
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:54 SCOTT ADAM RD
Mailing Address - Street 2:STE 106
Mailing Address - City:COCKEYSVILLE HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3216
Mailing Address - Country:US
Mailing Address - Phone:410-683-1220
Mailing Address - Fax:410-683-1235
Practice Address - Street 1:54 SCOTT ADAM RD
Practice Address - Street 2:STE 106
Practice Address - City:COCKEYSVILLE HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21030-3216
Practice Address - Country:US
Practice Address - Phone:410-683-1220
Practice Address - Fax:410-683-1235
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDDO014339208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DO1405Medicare UPIN