Provider Demographics
NPI:1083774681
Name:DESANTIS, EMILY P (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:P
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8825 BEE CAVES RD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-4721
Mailing Address - Country:US
Mailing Address - Phone:512-328-3376
Mailing Address - Fax:512-666-3767
Practice Address - Street 1:8825 BEE CAVES RD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-4721
Practice Address - Country:US
Practice Address - Phone:512-328-3376
Practice Address - Fax:512-666-3767
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP4943207ND0900X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM349713009Medicare PIN
NM349713011Medicare PIN
NMNM301493Medicare PIN
NM349713008Medicare PIN
NM349713010Medicare PIN
NMNM301494Medicare PIN
NM349713012Medicare PIN