Provider Demographics
NPI:1710952932
Name:SANTILLAN, VICTOR H (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:H
Last Name:SANTILLAN
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 1:200 HOSPITAL DR
Mailing Address - Street 2:STE 1
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-1825
Mailing Address - Country:US
Mailing Address - Phone:814-684-5399
Mailing Address - Fax:814-684-3835
Practice Address - Street 1:200 HOSPITAL DR
Practice Address - Street 2:STE 1
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-1825
Practice Address - Country:US
Practice Address - Phone:814-684-5399
Practice Address - Fax:814-684-3835
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018158E208600000X, 208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008308270002Medicaid
PA0008308270002Medicaid
PA075227Medicare ID - Type Unspecified