Provider Demographics
NPI:1366536013
Name:SANTRAM, DEEPAK (MD)
Entity type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:
Last Name:SANTRAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FAIRHILL DR
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9337
Mailing Address - Country:US
Mailing Address - Phone:610-388-2494
Mailing Address - Fax:610-869-1131
Practice Address - Street 1:4 FAIRHILL DR
Practice Address - Street 2:
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9337
Practice Address - Country:US
Practice Address - Phone:610-388-2494
Practice Address - Fax:610-869-1131
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034333L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB37496Medicare UPIN