Provider Demographics
NPI:1679540140
Name:VIOLAGO, EDUARDO SANTIAGO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:SANTIAGO
Last Name:VIOLAGO
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 1:2151 LINGLESTOWN RD
Mailing Address - Street 2:STE. 240
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-9499
Mailing Address - Country:US
Mailing Address - Phone:717-541-0700
Mailing Address - Fax:717-541-5100
Practice Address - Street 1:2151 LINGLESTOWN RD
Practice Address - Street 2:STE. 240
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9499
Practice Address - Country:US
Practice Address - Phone:717-541-0700
Practice Address - Fax:717-541-5100
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037744L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0648965Medicaid
PA0648965Medicaid