Provider Demographics
NPI:1659459923
Name:MORAO, SANTIAGO DUMLAO JR (MD)
Entity Type:Individual
Prefix:MR
First Name:SANTIAGO
Middle Name:DUMLAO
Last Name:MORAO
Suffix:JR
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 1:6357 OXON HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745
Mailing Address - Country:US
Mailing Address - Phone:301-839-2700
Mailing Address - Fax:301-839-1354
Practice Address - Street 1:6357 OXON HILL ROAD
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745
Practice Address - Country:US
Practice Address - Phone:301-839-2700
Practice Address - Fax:301-839-1354
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD12882208600000X
MDD0024687208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00433Medicare ID - Type Unspecified
E30372Medicare UPIN