Provider Demographics
NPI:1457309833
Name:SANTOS, MINERVA (MD)
Entity Type:Individual
Prefix:DR
First Name:MINERVA
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:MOUNT. KISCO MEDICAL GROUP, PC
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-248-4091
Practice Address - Street 1:3680 HILL BLVD
Practice Address - Street 2:MOUNT KISCO MEDICAL GROUP, PC
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535-1500
Practice Address - Country:US
Practice Address - Phone:914-241-1050
Practice Address - Fax:914-248-4091
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-12-19
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Provider Licenses
StateLicense IDTaxonomies
NY176846207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01476475Medicaid
NYA400054216Medicare PIN
NY01476475Medicaid