Healthcare Provider Details

I. General information

NPI: 1871609321
Provider Name (Legal Business Name): MICHAEL J SANTIAGO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 N CHARLES ST
TOWSON MD
21204-6881
US

IV. Provider business mailing address

308 W WIND RD
TOWSON MD
21204-6740
US

V. Phone/Fax

Practice location:
  • Phone: 585-478-7891
  • Fax:
Mailing address:
  • Phone: 585-478-7891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberH79258
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number253190-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: