Provider Demographics
NPI:1922259308
Name:SANTAULARIA TOMAS, MIGUEL (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:SANTAULARIA TOMAS
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 1:3900 N CHARLES ST
Mailing Address - Street 2:APARTMENT 306
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1756
Mailing Address - Country:US
Mailing Address - Phone:443-938-0928
Mailing Address - Fax:410-502-3539
Practice Address - Street 1:720 RUTLAND AVE
Practice Address - Street 2:JOHNS HOPKINS UNIVERSITY ROSS BUILDING, ROOM 1044
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-2109
Practice Address - Country:US
Practice Address - Phone:410-502-2505
Practice Address - Fax:410-502-2529
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ZZ5472230207RC0000X
ZZ4008395208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice