Provider Demographics
NPI:1801088752
Name:RICHARD J. SANTANGELO, D.C., P.C.
Entity type:Organization
Organization Name:RICHARD J. SANTANGELO, D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SANTANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-663-8610
Mailing Address - Street 1:4303 FITCH AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-3717
Mailing Address - Country:US
Mailing Address - Phone:410-663-8610
Mailing Address - Fax:410-663-8613
Practice Address - Street 1:4303 FITCH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-3717
Practice Address - Country:US
Practice Address - Phone:410-663-8610
Practice Address - Fax:410-663-8613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD40068401OtherCARE FIRST RENDERING NO.
MDW371 0001OtherDC PLAN PROVIDER NUMBER
MDW371 0001OtherDC PLAN PROVIDER NUMBER
MDK022R439Medicare PIN
MD40068401OtherCARE FIRST RENDERING NO.