Provider Demographics
NPI:1386857118
Name:SANTANGELO, RICHARD JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAMES
Last Name:SANTANGELO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 FITCH AVE
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-3717
Mailing Address - Country:US
Mailing Address - Phone:410-663-8610
Mailing Address - Fax:443-420-1001
Practice Address - Street 1:4303 FITCH AVE
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-3717
Practice Address - Country:US
Practice Address - Phone:410-663-8610
Practice Address - Fax:443-420-1001
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD40068401OtherCAREFIRST RENDERING NO.
MDW371 0001OtherDC PLAN PROVIDER NO.
MDW371 0001OtherDC PLAN PROVIDER NO.
MDW75728Medicare UPIN
MD40068401OtherCAREFIRST RENDERING NO.