Provider Demographics
NPI:1629040209
Name:SANTORIELLO, SAMUEL C (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:C
Last Name:SANTORIELLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 PULASKI PARK DR
Mailing Address - Street 2:SUITE 416
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1409
Mailing Address - Country:US
Mailing Address - Phone:410-933-5678
Mailing Address - Fax:410-933-1823
Practice Address - Street 1:6660 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-1844
Practice Address - Country:US
Practice Address - Phone:410-444-2000
Practice Address - Fax:410-254-9554
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1539374OtherCAQH
MD535829OtherCAREFIRST
MD535829OtherCAREFIRST
MDU18320Medicare UPIN