Provider Demographics
NPI:1811077274
Name:SANTULLI, MICHAEL EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:SANTULLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1405 ROLKIN CT STE 201
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-3586
Mailing Address - Country:US
Mailing Address - Phone:434-295-5155
Mailing Address - Fax:434-295-4612
Practice Address - Street 1:1405 ROLKIN CT STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-3586
Practice Address - Country:US
Practice Address - Phone:434-295-5155
Practice Address - Fax:434-295-4612
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046691207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006063306Medicaid
VA070176OtherANTHEM
VA070176OtherANTHEM
460003464Medicare PIN
110003975Medicare PIN