Provider Demographics
NPI:1235139866
Name:BORGANELLI, SANTO M (MD FACC)
Entity Type:Individual
Prefix:
First Name:SANTO
Middle Name:M
Last Name:BORGANELLI
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 SOUTH 28TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401
Mailing Address - Country:US
Mailing Address - Phone:601-268-5800
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:415 SOUTH 28TH AVENUE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401
Practice Address - Country:US
Practice Address - Phone:601-268-5800
Practice Address - Fax:601-261-3530
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20405207RC0001X
FLME62138207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09933313Medicaid
AL009304150Medicaid
FL3721922 00Medicaid
AL009304150Medicaid
MS09933313Medicaid
FL3721922 00Medicaid
MSP01175958Medicare PIN
MSP00639240Medicare PIN
MSP00639240Medicare PIN