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Individual

IRMA MARIANA SANTIAGO LAGO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
102 POMONA DR, GREENSBORO, NC 27407
(336) 299-0000
(336) 299-2335
Mailing address
102 POMONA DR, GREENSBORO, NC 27407-1616
(336) 299-0000
(336) 299-2335

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2018-00102
NC
207Q00000X
Family Medicine Physician
MD2012-0350
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
85784842
NM
01
NMA102941
MEDICARE PTAN
Enumeration date
03/30/2009
Last updated
10/01/2021
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