Provider Demographics
NPI:1487730719
Name:SANTOS, NORMAN VERCHES (MD)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:VERCHES
Last Name:SANTOS
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:PO BOX 4059
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07474-4059
Mailing Address - Country:US
Mailing Address - Phone:973-826-8540
Mailing Address - Fax:855-834-5434
Practice Address - Street 1:695 ROUTE 46 W
Practice Address - Street 2:SUITE 400A
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-1592
Practice Address - Country:US
Practice Address - Phone:973-826-8080
Practice Address - Fax:855-834-5434
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05260900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ577110Medicare PIN
NJ577110YP69Medicare PIN
NJ577110B4MOtherGRP PTAN HOSPITAL