Healthcare Provider Details

I. General information

NPI: 1649764283
Provider Name (Legal Business Name): SANTANU SAMANTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 08/26/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 SPRINGHILL DRIVE BAPTIST HEALTH SPRINGHILL MEDICAL PLAZA FIRST FLOOR
NORTH LITTLE ROCK AR
72117
US

IV. Provider business mailing address

4301 W MARKHAM ST # 783
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-3000
  • Fax:
Mailing address:
  • Phone: 501-686-8000
  • Fax: 501-526-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberE-15152
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: