Provider Demographics
NPI:1275533580
Name:DELOS SANTOS, NOEL M (MD)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:M
Last Name:DELOS SANTOS
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 1:51 N DUNLAP ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-4625
Mailing Address - Country:US
Mailing Address - Phone:901-287-5674
Mailing Address - Fax:901-287-6804
Practice Address - Street 1:51 N DUNLAP ST STE 400
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105
Practice Address - Country:US
Practice Address - Phone:901-287-7337
Practice Address - Fax:901-287-5506
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36683207PP0204X, 2080P0210X, 2080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3496781Medicaid
TNH75221Medicare UPIN
TN3880535Medicare ID - Type Unspecified
3880535Medicare PIN