Provider Demographics
NPI:1245430933
Name:LENNON, ANGELA ELAINE SANTIAGO (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA ELAINE
Middle Name:SANTIAGO
Last Name:LENNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA ELAINE
Other - Middle Name:HERNANDEZ
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:
Practice Address - Street 1:9427 SW BARNES RD STE 395
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6652
Practice Address - Country:US
Practice Address - Phone:503-216-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-342562080P0205X
ORMD1799392080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology