Provider Demographics
NPI:1689873713
Name:SANTORO, THOMAS DELANEY (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DELANEY
Last Name:SANTORO
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 602658
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2658
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-716-3202
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:DEPT. OF RADIOLOGY
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-7849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-006062085R0202X, 390200000X
VA0116019486390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810026100OtherWV MEDICAID
NC1689873713Medicaid
VA0116019486OtherVIRGINIA MEDICAL LICENSE
NC3651467OtherUNITED HEALTHCARE
VA1689873713OtherVIRGINIA MEDICAID
NC1689873713OtherPARTNERS
NC179TAOtherBCBS
NC26767OtherMEDCOST
NC1689873713OtherTRICARE
NC2012-00606OtherNC MEDICAL LICENSE
TN46999OtherTENNESSEE MEDICAL LICENSE
NCNCD209AMedicare PIN