Basic Information
| Provider Information | |||||||||
| NPI: | 1942250535 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTORO | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 BOREN AVE | ||||||||
| Address2: | #800 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981043534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063231900 | ||||||||
| FaxNumber: | 2063236868 | ||||||||
| Practice Location | |||||||||
| Address1: | 12333 NE 130TH LANE | ||||||||
| Address2: | #400 | ||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980347467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063231900 | ||||||||
| FaxNumber: | 2063236868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 11/04/2010 | ||||||||
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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 | 207XX0005X | MD00025701 | WA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2356SA | 01 | WA | REGENCE BLUE SHIELD | OTHER | 2356SA | 01 | REGENCE | OTHER | 0204542 | 01 | WA | WA STATE LABOR & INDUST | OTHER | 0204542 | 01 | L & I | OTHER |