Provider Demographics
NPI:1235484056
Name:MAZUERA MEJIA, SANTIAGO (MD)
Entity Type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:
Last Name:MAZUERA MEJIA
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 1:5051 GREENSPRING AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4354
Mailing Address - Country:US
Mailing Address - Phone:410-601-9515
Mailing Address - Fax:410-601-8905
Practice Address - Street 1:5951 GREENSPRING AVENUE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4354
Practice Address - Country:US
Practice Address - Phone:410-601-9515
Practice Address - Fax:410-601-8905
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4584232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology