Provider Demographics
NPI:1306891148
Name:SANTIAGO, CARLOS SORIANO III (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:SORIANO
Last Name:SANTIAGO
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:301-777-2543
Mailing Address - Fax:301-777-2583
Practice Address - Street 1:940 SETON DR
Practice Address - Street 2:SUITE A
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1818
Practice Address - Country:US
Practice Address - Phone:301-777-2543
Practice Address - Fax:301-777-2583
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2017-02-21
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Provider Licenses
StateLicense IDTaxonomies
MDD0027107208VP0014X, 208VP0014X
MDD27107207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD170752ZFN7Medicare PIN
MDD01245Medicare UPIN
MD322321300Medicaid