Individual provider Active NPI

Wanda I. Santiago, M.D.

  • Family Medicine Physician
  • Charles Town, WV
National Provider Identifier
1457494403
Registry record updated Apr 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
12442 Issued in PR
Practice address
186 Potomac Crossing St
Charles Town, WV 25414-1052
Phone
(304) 616-0800
NPI assigned
Feb 15, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 17, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 12442 PR Primary

Addresses

Primary practice location

186 Potomac Crossing St
Charles Town, WV 25414-1052

Mailing address

186 Potomac Crossing St
Charles Town, WV 25414-1052
Phone (304) 616-0800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190906000247 WV Order and Referring Only - Family PracticePractitioner - Family Practice 5890024541

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
12442PRMDFamily Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776384000000",
    "number": "1457494403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "186 POTOMAC CROSSING ST",
            "city": "CHARLES TOWN",
            "state": "WV",
            "postal_code": "254141052",
            "telephone_number": "304-616-0800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "186 POTOMAC CROSSING ST",
            "city": "CHARLES TOWN",
            "state": "WV",
            "postal_code": "254141052",
            "telephone_number": "304-616-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTIAGO",
        "first_name": "WANDA",
        "middle_name": "I.",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-15",
        "last_updated": "2026-04-17",
        "certification_date": "2026-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PR",
            "license": "12442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charles Town, WV

Sources for this page

Verify at the official NPI Registry.