Provider Demographics
NPI:1578731972
Name:ROBERT SANTIAGO, MD, INC.
Entity Type:Organization
Organization Name:ROBERT SANTIAGO, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-431-8869
Mailing Address - Street 1:247 GLEN VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9677
Mailing Address - Country:US
Mailing Address - Phone:614-431-8869
Mailing Address - Fax:614-431-9910
Practice Address - Street 1:396 PORTLAND WAY N
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-1115
Practice Address - Country:US
Practice Address - Phone:419-462-5543
Practice Address - Fax:419-462-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-7517208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35-05-7517OtherOHIO MEDICAL LICENSE
$$$$$$$$$OtherSSN
OH0759362Medicaid
OH107669OtherWORKER'S COMP. EMPL. RISK
1720121213OtherINDIVIDUAL (TYPE 1) NPI
OHBS165421OtherFEDEAL DEA NUMBER
OHBS165421OtherFEDEAL DEA NUMBER