Provider Demographics
NPI:1487668372
Name:SANTOS, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:SANTOS
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 1:1700 HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:SUITE 200
Mailing Address - State:PA
Mailing Address - Zip Code:18914
Mailing Address - Country:US
Mailing Address - Phone:215-822-7700
Mailing Address - Fax:215-822-2296
Practice Address - Street 1:1700 HORIZON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914
Practice Address - Country:US
Practice Address - Phone:215-822-7700
Practice Address - Fax:215-822-2296
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-064193-L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG28773Medicare UPIN