Healthcare Provider Details

I. General information

NPI: 1760476907
Provider Name (Legal Business Name): ANGELA M SANTINI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19450 DEERFIELD AVE 175
LANSDOWNE VA
20176-6820
US

IV. Provider business mailing address

19450 DEERFIELD AVE STE 175
LEESBURG VA
20176-8425
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-5454
  • Fax: 703-858-4650
Mailing address:
  • Phone: 703-383-9543
  • Fax: 703-383-9532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101052497
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: