=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003479825
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARSHA FRANCES SANTANGELO MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2019
-----------------------------------------------------
Last Update Date | 04/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 SAWGRASS DRIVE
-----------------------------------------------------
City | BLUE BELL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-430-3069
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 107 SAWGRASS DRIVE
-----------------------------------------------------
City | BLUE BELL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-430-3069
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | MD037343E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------