Healthcare Provider Details

I. General information

NPI: 1013019892
Provider Name (Legal Business Name): MARISEL SANTIAGO GONZALEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARISEL SANTIAGO M.D.

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21444 CARMEAN WAY
GEORGETOWN DE
19947-4572
US

IV. Provider business mailing address

21444 CARMEAN WAY
GEORGETOWN DE
19947-4572
US

V. Phone/Fax

Practice location:
  • Phone: 302-855-2020
  • Fax: 302-855-2025
Mailing address:
  • Phone: 302-855-1233
  • Fax: 302-855-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number10609
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0009135
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: