Healthcare Provider Details

I. General information

NPI: 1841373149
Provider Name (Legal Business Name): MARTA E SANTOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 BRIDGEBORO RD STE C
DELRAN NJ
08075-9716
US

IV. Provider business mailing address

401 ROUTE 73 N BLDG 10, SUITE 320 ST CHRISTOPHER'S HOSPITAL FOR CHILDREN
MARLTON NJ
08053
US

V. Phone/Fax

Practice location:
  • Phone: 856-461-1717
  • Fax:
Mailing address:
  • Phone: 856-872-7055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD428891
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA09023900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: