Provider Demographics
NPI:1205827144
Name:SANTOS, YOLANDA A (MD)
Entity Type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:A
Last Name:SANTOS
Suffix:
Gender:F
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:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25802-0580
Mailing Address - Country:US
Mailing Address - Phone:304-763-3674
Mailing Address - Fax:
Practice Address - Street 1:106 HAWTHORN LN
Practice Address - Street 2:
Practice Address - City:DANIELS
Practice Address - State:WV
Practice Address - Zip Code:25832-9269
Practice Address - Country:US
Practice Address - Phone:304-763-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13221174400000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001720560OtherBC
WV0048997000Medicaid
WV080141780OtherW COMP
WV080141780OtherW COMP
WVD49493Medicare UPIN