Provider Demographics
NPI:1669780847
Name:SANTIAGO, GINA (PA)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MACK BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:484-884-0551
Mailing Address - Fax:484-884-0628
Practice Address - Street 1:2649 SCHOENERSVILLE RD STE 202
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7316
Practice Address - Country:US
Practice Address - Phone:484-884-1007
Practice Address - Fax:570-656-4111
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055285363A00000X, 363AM0700X
NY014360363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical