Basic Information
| Provider Information | |||||||||
| NPI: | 1336220623 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANTOGADE | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1002 N CHURCH ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363780713 | ||||||||
| FaxNumber: | 3362739060 | ||||||||
| Practice Location | |||||||||
| Address1: | 1002 N CHURCH ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363780713 | ||||||||
| FaxNumber: | 3362739060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 207RG0100X | 9801047 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 89940 | 01 | NC | MEDCOST | OTHER | 26292 | 01 | NC | PARTNERS MEDICARE | OTHER | 891163P | 05 | NC | MEDICAID | 1163P | 01 | NC | BCBS OF NC | OTHER |