Provider Demographics
NPI:1295700482
Name:SANTIAGO-RODRIGUEZ, TIRZA S (MD)
Entity type:Individual
Prefix:
First Name:TIRZA
Middle Name:S
Last Name:SANTIAGO-RODRIGUEZ
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 1:109 G GAINSBOROUGH SQUARE
Mailing Address - Street 2:BOX 723
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320
Mailing Address - Country:US
Mailing Address - Phone:757-490-9388
Mailing Address - Fax:757-490-9401
Practice Address - Street 1:736 BATTLEFIELD BLVD N
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320
Practice Address - Country:US
Practice Address - Phone:757-312-6200
Practice Address - Fax:757-312-6181
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92659207P00000X
PAMD429320207P00000X
PR15098207P00000X
VA0101252749207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272295000Medicaid
FL03410OtherBCBS
FL03410AMedicare ID - Type Unspecified
FL272295000Medicaid