Provider Demographics
NPI:1134221195
Name:SANTOS, CECILIA L (MD)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:L
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5875 BREMO RD
Mailing Address - Street 2:SUITE 709
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1934
Mailing Address - Country:US
Mailing Address - Phone:804-673-8160
Mailing Address - Fax:804-673-8165
Practice Address - Street 1:5875 BREMO RD
Practice Address - Street 2:SUITE 709
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1934
Practice Address - Country:US
Practice Address - Phone:804-673-8160
Practice Address - Fax:804-673-8165
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222073-1207R00000X
VA0101244417207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000086819OtherGHI HMO
NY02309497Medicaid
VAC06695OtherGROUP PTAN
118512OtherMVP
NY02309497Medicaid