Provider Demographics
NPI:1295760940
Name:SANTANGELO, RICHARD G (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:SANTANGELO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 GLENWAY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-6378
Mailing Address - Country:US
Mailing Address - Phone:513-481-9700
Mailing Address - Fax:513-389-7091
Practice Address - Street 1:6350 GLENWAY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6378
Practice Address - Country:US
Practice Address - Phone:513-481-9700
Practice Address - Fax:513-389-7091
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35031888208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0328390Medicaid
OHG21884Medicare UPIN