Provider Demographics
NPI:1346319944
Name:SANTIAGO, MELANIE OPPENHEIM (PA-C)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:OPPENHEIM
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5458 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3732
Mailing Address - Country:US
Mailing Address - Phone:215-487-1887
Mailing Address - Fax:
Practice Address - Street 1:5458 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3732
Practice Address - Country:US
Practice Address - Phone:215-487-1887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA151080363A00000X
PAOA000813363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ17966Medicare UPIN