Provider Demographics
NPI:1679762306
Name:SANTIANNI, KIRSTEN A (DO)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:A
Last Name:SANTIANNI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:ADELE
Other - Last Name:SANTIANNI-GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:7924 CHESAPEAKE BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-3801
Practice Address - Country:US
Practice Address - Phone:757-587-1700
Practice Address - Fax:757-480-1295
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102037228207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine