Provider Demographics
NPI:1689652281
Name:SANTOS, EDWIN (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:SANTOS
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:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:KY
Mailing Address - Zip Code:41301-0099
Mailing Address - Country:US
Mailing Address - Phone:606-668-9076
Mailing Address - Fax:606-668-7488
Practice Address - Street 1:31 MAIN ST
Practice Address - Street 2:CAMPTON MEDICAL ARTS, SUITE I
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301-9750
Practice Address - Country:US
Practice Address - Phone:606-668-9076
Practice Address - Fax:606-668-7488
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32898174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64328982Medicaid
KYG82143Medicare UPIN
KY0759201Medicare ID - Type Unspecified