Basic Information
| Provider Information | |||||||||
| NPI: | 1285739425 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTOIAN | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 850001 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328850176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522377646 | ||||||||
| FaxNumber: | 3522910361 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 SW 11TH ST | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344710967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523549000 | ||||||||
| FaxNumber: | 3526200255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 04/17/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | ME69318 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 21056 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 252872000 | 05 | FL | MEDICAID |