Provider Demographics
NPI:1639269970
Name:SANTORO, FRED E (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:E
Last Name:SANTORO
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 1:15 CHESTERFIELD RD
Mailing Address - Street 2:PO BOX 159
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1730
Mailing Address - Country:US
Mailing Address - Phone:860-739-0404
Mailing Address - Fax:860-739-1881
Practice Address - Street 1:15 CHESTERFIELD RD
Practice Address - Street 2:FLANDERS PLAZA, SUITE 214
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333-1730
Practice Address - Country:US
Practice Address - Phone:860-739-0404
Practice Address - Fax:860-739-1881
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029410208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NLP070OtherOXFORD
010029410CT02OtherBLUE CROSS/BLUE SHIED
01029410OtherCIGNA
504764OtherAETNA
029410OtherCONNECTICARE
031515OtherHEALTHNET