Provider Demographics
NPI:1659508570
Name:FERNANDO, RAJEEV SANTIAGO (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJEEV
Middle Name:SANTIAGO
Last Name:FERNANDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2340
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11969-2340
Mailing Address - Country:US
Mailing Address - Phone:631-283-2430
Mailing Address - Fax:631-283-7496
Practice Address - Street 1:325 MEETING HOUSE LN
Practice Address - Street 2:BUILDING #2
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5087
Practice Address - Country:US
Practice Address - Phone:631-283-4048
Practice Address - Fax:631-283-5396
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2011-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY255938207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400058523Medicare PIN