Provider Demographics
NPI:1144428160
Name:SANTRY, HEENA P (MD)
Entity Type:Individual
Prefix:DR
First Name:HEENA
Middle Name:P
Last Name:SANTRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HEENA
Other - Middle Name:PRAVIN
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8068
Practice Address - Street 1:3533 SOUTHERN BLVD STE 2100
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1267
Practice Address - Country:US
Practice Address - Phone:937-395-8556
Practice Address - Fax:937-395-6376
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH351319032086S0102X, 2086S0102X
OH35.131903208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0238222Medicaid
MA110081745AMedicaid