Healthcare Provider Details

I. General information

NPI: 1902533383
Provider Name (Legal Business Name): MOISES SANTANA SANTANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 VINE ST
HARTFORD CT
06112-1639
US

IV. Provider business mailing address

500 UNIVERSITY DR
HERSHEY PA
17033-2360
US

V. Phone/Fax

Practice location:
  • Phone: 860-293-6400
  • Fax:
Mailing address:
  • Phone: 717-531-8521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number83174
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: