Provider Demographics
NPI:1598136996
Name:SANTAMARIA, GREGORY (DPM)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:SANTAMARIA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 ARDMORE DR APT 204
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-6318
Mailing Address - Country:US
Mailing Address - Phone:570-977-8942
Mailing Address - Fax:
Practice Address - Street 1:1112 JOHNNIE DODDS BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3131
Practice Address - Country:US
Practice Address - Phone:843-981-5008
Practice Address - Fax:843-981-5016
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC657213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery