Healthcare Provider Details

I. General information

NPI: 1336241272
Provider Name (Legal Business Name): GERARD SANTOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARTHA JEFFERSON DR FL 5
CHARLOTTESVILLE VA
22911-4668
US

IV. Provider business mailing address

PO BOX 746550
ATLANTA GA
30374-6550
US

V. Phone/Fax

Practice location:
  • Phone: 434-654-5260
  • Fax: 844-340-9731
Mailing address:
  • Phone: 882-362-2638
  • Fax: 757-390-4551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number219494-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberD84510
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number0101244220
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: