Healthcare Provider Details

I. General information

NPI: 1790051134
Provider Name (Legal Business Name): ROBERTO CANDELARIA-SANTIAGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PURPLE HEART AVE
DOVER DE
19902-5051
US

IV. Provider business mailing address

8901 WISCONSIN AVE
BETHESDA MD
20889-2095
US

V. Phone/Fax

Practice location:
  • Phone: 302-346-8724
  • Fax:
Mailing address:
  • Phone: 301-295-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number78172
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number27995
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number27995
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: