Healthcare Provider Details

I. General information

NPI: 1679762306
Provider Name (Legal Business Name): KIRSTEN A SANTIANNI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSTEN ADELE SANTIANNI-GREEN

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7924 CHESAPEAKE BLVD
NORFOLK VA
23518-3801
US

IV. Provider business mailing address

PO BOX 7068
PORTSMOUTH VA
23707-0068
US

V. Phone/Fax

Practice location:
  • Phone: 757-587-1700
  • Fax: 757-480-1295
Mailing address:
  • Phone: 757-686-3508
  • Fax: 757-686-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102037228
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: