Provider Demographics
NPI:1316145196
Name:SANTIAGO, YARIMA SOL (MD)
Entity type:Individual
Prefix:
First Name:YARIMA
Middle Name:SOL
Last Name:SANTIAGO
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 1:29C COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1206
Mailing Address - Country:US
Mailing Address - Phone:413-549-8888
Mailing Address - Fax:
Practice Address - Street 1:29C COTTAGE ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1206
Practice Address - Country:US
Practice Address - Phone:413-549-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA247320207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA53160OtherHEALTH NEW ENGLAND
MA110092196AMedicaid
MA5520493OtherCONNECTICARE
MAAA231499OtherHARVARD PILGRIM HEALTH PLAN
MAJ49837OtherBCBS OF MASSACHUSETTS
MA223853OtherTUFTS HEALTH PLAN
MA002597901Medicare PIN