Provider Demographics
NPI:1316925787
Name:BARTHOLOMEW, SANTA JOAN (MD)
Entity type:Individual
Prefix:DR
First Name:SANTA
Middle Name:JOAN
Last Name:BARTHOLOMEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SANTA
Other - Middle Name:JOAN
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2818
Practice Address - Country:US
Practice Address - Phone:252-744-5871
Practice Address - Fax:252-744-5759
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049567208000000X, 2080P0203X
NC2012-023132080P0203X
IN01062804A2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19AJ4OtherBCBS
VA6722342Medicaid
MD150621800Medicaid
WV1802333000Medicaid
NCNCM4000322OtherMEDICARE
PA0017060070001Medicaid
DE1000035271Medicaid
NC1316925787Medicaid