Provider Demographics
NPI:1003806621
Name:DESANTOLA, JOSEPH R (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:DESANTOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-5616
Mailing Address - Fax:828-650-8076
Practice Address - Street 1:50 HOSPITAL DR
Practice Address - Street 2:SUITE 3B2
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5248
Practice Address - Country:US
Practice Address - Phone:828-687-0088
Practice Address - Fax:828-684-6693
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032977E207RC0000X
NC201201997207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP01248130OtherMEDICARE RR
NC176U7OtherBCBS NC
B42221Medicare UPIN
NCNCA658AMedicare PIN