Provider Demographics
NPI:1649244732
Name:SANTIAGO, DEREK W (MD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:W
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:443-621-7358
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:435 SOUTH ST STE 240A
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6422
Practice Address - Country:US
Practice Address - Phone:973-292-1020
Practice Address - Fax:973-292-9405
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06404600207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF78479Medicare UPIN
533334QRXMedicare ID - Type Unspecified