Basic Information
| Provider Information | |||||||||
| NPI: | 1285810424 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIDO SANTOS | ||||||||
| FirstName: | ENGEL | ||||||||
| MiddleName: | BERTO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 QUINCY AVE | ||||||||
| Address2: | |||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023022803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089417268 | ||||||||
| FaxNumber: | 5089417850 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 QUINCY AVE | ||||||||
| Address2: | |||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023022803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089417268 | ||||||||
| FaxNumber: | 5089417850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2008 | ||||||||
| LastUpdateDate: | 05/09/2013 | ||||||||
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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 | 207R00000X | 235211 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.