Provider Demographics
NPI:1942250535
Name:SANTORO, VINCENT M (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:M
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 1:901 BOREN AVE
Mailing Address - Street 2:#800
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3534
Mailing Address - Country:US
Mailing Address - Phone:206-323-1900
Mailing Address - Fax:206-323-6868
Practice Address - Street 1:12333 NE 130TH LANE
Practice Address - Street 2:#400
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7467
Practice Address - Country:US
Practice Address - Phone:206-323-1900
Practice Address - Fax:206-323-6868
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025701207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2356SAOtherREGENCE BLUE SHIELD
2356SAOtherREGENCE
WA0204542OtherWA STATE LABOR & INDUST
0204542OtherL & I
WA0204542OtherWA STATE LABOR & INDUST
E35573Medicare UPIN
2356SAOtherREGENCE
8860029Medicare PIN