Provider Demographics
NPI:1578647418
Name:SANTANGELO, CHRISTOPHER M (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:SANTANGELO
Suffix:
Gender:M
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 1:3703 TEAYS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9645
Mailing Address - Country:US
Mailing Address - Phone:304-757-2273
Mailing Address - Fax:304-760-9290
Practice Address - Street 1:3703 TEAYS VALLEY RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9645
Practice Address - Country:US
Practice Address - Phone:304-760-9250
Practice Address - Fax:304-760-9290
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV238363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00661059Medicare PIN
WVSAPA17665Medicare PIN