Provider Demographics
NPI:1952348724
Name:SANTANA, DOMINGO ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:DOMINGO
Middle Name:ANTONIO
Last Name:SANTANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2869 GRAND CONCOURSE
Mailing Address - Street 2:STE 1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1966
Mailing Address - Country:US
Mailing Address - Phone:718-767-4177
Mailing Address - Fax:718-676-4179
Practice Address - Street 1:2869 GRAND CONCOURSE
Practice Address - Street 2:STE 1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1966
Practice Address - Country:US
Practice Address - Phone:718-676-4177
Practice Address - Fax:718-676-4179
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2017-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY239271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI52538Medicare UPIN