Provider Demographics
NPI:1326261348
Name:SALLABERRY-MORCIGLIO, SANTIAGO N (MD)
Entity Type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:N
Last Name:SALLABERRY-MORCIGLIO
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 1:2225 PONCE BYP STE 105
Mailing Address - Street 2:PONCE BY PASS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1322
Mailing Address - Country:US
Mailing Address - Phone:787-843-3080
Mailing Address - Fax:787-259-1585
Practice Address - Street 1:2225 PONCE BYP STE 105
Practice Address - Street 2:PONCE BY PASS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1322
Practice Address - Country:US
Practice Address - Phone:787-843-3080
Practice Address - Fax:787-259-1585
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD08264Medicare UPIN
PR0024196Medicare ID - Type UnspecifiedMEDICARE PROVIDER #