Provider Demographics
NPI:1912049909
Name:SANTIAGO NOA, VICTOR MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:MANUEL
Last Name:SANTIAGO NOA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7319 MAIN ST
Mailing Address - Street 2:HARRISBURG
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-8975
Mailing Address - Country:US
Mailing Address - Phone:717-903-8277
Mailing Address - Fax:717-566-3320
Practice Address - Street 1:2001 N FRONT ST
Practice Address - Street 2:STE. 324-326
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17102-2118
Practice Address - Country:US
Practice Address - Phone:717-903-8277
Practice Address - Fax:717-566-3320
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR43532084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008741980005Medicaid