Provider Demographics
NPI:1922407196
Name:SANTOS, RALPH JOSEPH
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:JOSEPH
Last Name:SANTOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6202 GIST AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3608
Mailing Address - Country:US
Mailing Address - Phone:410-292-8725
Mailing Address - Fax:877-353-0384
Practice Address - Street 1:5840 BANNEKER RD, STE 230
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3103
Practice Address - Country:US
Practice Address - Phone:410-884-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist