Provider Demographics
NPI:1336103308
Name:SANTIESTEBAN, ROBERTO P (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:P
Last Name:SANTIESTEBAN
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 1:108 HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450
Mailing Address - Country:US
Mailing Address - Phone:540-463-2227
Mailing Address - Fax:540-463-3833
Practice Address - Street 1:108 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2455
Practice Address - Country:US
Practice Address - Phone:540-463-2227
Practice Address - Fax:540-463-3833
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-248463208600000X
FLME37267208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1336103308Medicaid
VAVAA104288Medicare PIN
FLD-63582Medicare UPIN