Provider Demographics
NPI:1053584037
Name:PUNZALAN, CARMI SANTOS (MD)
Entity type:Individual
Prefix:DR
First Name:CARMI
Middle Name:SANTOS
Last Name:PUNZALAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CARMI
Other - Middle Name:MARTHA
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41 MALL ROAD
Mailing Address - Street 2:LAHEY HOSPITAL & MEDICAL CENTER
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8000
Mailing Address - Fax:781-744-5743
Practice Address - Street 1:41 MALL ROAD
Practice Address - Street 2:LAHEY HOSPITAL & MEDICAL CENTER
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805
Practice Address - Country:US
Practice Address - Phone:781-744-8000
Practice Address - Fax:781-744-5743
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA262302207RG0100X, 207RT0003X
CAA140736207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0265551Medicaid
PA102614243Medicaid
NJ0265551Medicaid